Research article

Prophylactic cranial irradiation in small cell lung cancer: a systematic review of the literature with meta-analysis

Anne-Pascale Meert¹ , Marianne Paesmans¹ , Thierry Berghmans¹ , Benoît Martin¹ , Céline Mascaux¹ , Frédéric Vallot¹ , Jean-Marc Verdebout³ , Jean-Jacques Lafitte² and Jean-Paul Sculier¹

¹  Service de Médecine, Institut Jules Bordet, Bruxelles, Belgique

²  Service de Pneumologie et d'Oncologie Thoracique, CHU Calmette, Lille, France

³  Service d'Anatomo-Pathologie, Institut Jules Bordet, Bruxelles, Belgique

author email corresponding author email

BMC Cancer 2001, 1:5doi:10.1186/1471-2407-1-5

Published:	19 June 2001

Abstract

Purpose

A systematic review of the literature was carried out to determine the role of prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC) .

Methods

To be eligible, full published trials needed to deal with SCLC and to have randomly assigned patients to receive PCI or not. Trials quality was assessed by two scores (Chalmers and ELCWP).

Results

Twelve randomised trials (1547 patients) were found to be eligible. Five evaluated the role of PCI in SCLC patients who had complete response (CR) after chemotherapy. Brain CT scan was done in the work-up in five studies and brain scintigraphy in six. Chalmers and ELCWP scores are well correlated (p < 0.001), with respective median scores of 32.6 and 38.8 %. This meta-analysis based on the available published data reveals a decrease of brain metastases incidence (hazard ratio (HR): 0.48; 95 % confidence interval (CI): 0.39 - 0.60) for all the studies and an improvement of survival (HR: 0.82; 95 % CI: 0.71 - 0.96) in patients in CR in favour of the PCI arm. Unfortunately, long-term neurotoxicity was not adequately described .

Conclusions

PCI decreases brain metastases incidence and improves survival in CR SCLC patients but these effects were obtained in patients who had no systematic neuropsychological and brain imagery assessments. The long-term toxicity has not been prospectively evaluated. If PCI can be recommended in patients with SCLC and CR documented by a work-up including brain CT scan, data are lacking to generalise its use to any CR situations.