非小细胞肺癌预防性全脑照射系统评价

目的 系统评价预防性全脑照射(PCI)对非小细胞肺癌(NSCLC)的有效性和安全性。方法 计算机检索Cochrane图书馆、MEDLINE、EMbase、中国生物医学文献数据库、中国期刊全文数据库和万方数据库,收集PCI治疗NSCLC的随机对照试验,由2名评价员按照纳入与排除标准选择文献、评价质量和提取资料,对符合纳入标准的研究用RevMan 5.1软件进行荟萃分析。结果 共纳入4个随机对照试验共 905例患者。与对照组(467例)相比,PCI组(438例)能减低脑转移率(χ²=1.98,P=0.000),但不延长 1年总生存率(χ²=1.12,P=0.880)。仅RTOG 2009一项试验对PCI相关不良反应及生活质量进行了较详实评价:简易精神状态检查(P=0.600)、日常生活能力量表(P=0.880)两组相似;1年时霍普金斯语言学习测验即时记忆(P=0.030)和延迟记忆(P=0.008) PCI组均下降。随访至 1年时PCI组与对照组的生活质量相似(P=0.050)。结论 PCI能减低NSCLC患者的脑转移率但并未延长总生存,尚需进一步临床试验证实。

Prophylactic cranial irradiation for non-small cell lung cancer: a systematic review

Objective To determine whether prophylactic cranial irradiation (PCI) has a role in the management of patients with non-small cell lung carcinoma (NSCLC) treated with radical intent. Methods We searched The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and VIP. The quality of the included studies was critically evaluated. Data analyses were performed using the Cochrane Collaboration′s RevMan 5.1 software. Results Four randomized controlled trials involving 905 patients met the inclusion criteria. The results meta-analyses showed the incidence of brain metastases was lower in PCI group compared with the observation group (χ²=1.98,P=0.000);but there is no evidence of 1-year overall survival (OS) benefit (χ²=1.12,P=0.880).Only RTOG 2009 provides prospective data:There were no significant differences in global cognitive function (P=0.600) or ADL (P=0.880) after PCI, but there was a significant decline in immediate recall (P=0.030) and delayed recall (P=0.008) at 1 year. At 1 year, there was no significant differences in QOL after PCI (P=0.050). Conclusions This systematic review show significantly decreases the risk of BM without improving 1-year OS in NSCLC patient receiving prophylactic cranial irradiation. There is insufficient evidence to support the use of PCI in clinical practice. Where possible, patients should be offered entry into a clinical trial.