| Objective At present, most research results showed that prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC) can obviously reduce the incidence of brain metastases, but for survival rate reported results are inconsistent, and optimal therapeutic doses of prophylactic cranial irradiation(PCI) is still not clear, other research results were also different. Therefore, the current study to evaluate the clinical value and optimal therapeutic dose of prophylactic cranial irradiation in patients with small cell lung cancer in complete remission. In order to provide radiation therapy for clinical practice evidence based medicine.Methods Randomized controlled trials (RCTs) were identified by PubMed (1966～2011.6), Cochrane Library(Issue6,2011),EMBASE(1974-2011.6),CNKI(1994-2011.6), CBM (1978-2011.6),VIP(1989～2011.6) and WanFang(1997～2011.6), as well as by various channels to obtain more relevant literature. RCT comparing prophylactic cranial irradiation versus no prophylactic cranial irradiation (no-PCI) in patients with small cell lung cancer in complete remission.The literature selection, methodologic quality of the assessment and data extraction of included studies was evaluated independently by two authors, and the results of homogeneous studies were analyzed with RevMan5.0software.Results Overall,15RCTs (2,233patients) were included in the meta-analysis (include9English and6Chinese papers), and13RCT for comparing PCI versus no PCI (no-PCI),2RCT for comparing standard-dose group (25Gy) versus higher-dose group (36Gy). Among the above15studies, five studies refer to specific randomized method, and three studies described the specific allocation concealment method, and three studies mentioned lost to follow-up. The other studies did not specifically describe of the method of randomization, allocation concealment and blinding. The mcta-analysis result showed that:①There were significant difference in1-,3-,5-year survival rate|OR-1.5|,95%CI(1.14～2.01),OR=1.77,95%CI(1.332.35),OR=1.57,95%CI(1.092.25)|, disease-free survival rate [OR=2.43,95%CI (1.763.34)|,brain metastases rate[OR=0.29.95%CI(0.19～0.46)|,other distant metastasis rate|OR-0.59.95%CI(0.43～0.80)] between PCI group and no-PCI group. But there was no significant difference in local recurrence rate|OR=0.89,95%CI (0.661.21)|between PCI group and no-PCI group;②To compared with higher-dose group, the standard-dose group can increase1-year overall survivai|OR=1.43,95%CI(1.07～1.92)] and1-year disease-free survival [OR=1.43,95%CI(1.05～1.95)|, and2-year overall survival,3-year overall survival,2-year disease-free survival,3-year disease-free survival had no difference between standard-dose group and higher-dose group, but1-year brain metastases rate was higher than higher-dose group.Conclusions Current available evidence demonstrate that PCI could improve the overall survival rate and disease-free survival rate. At the same time, and reduce the brain metastases and other distant metastasis rate in patients with small cell lung cancer. So it can be used as a kind of small cell lung cancer prevention and treatment method. The higher-dose PCI group did not significantly reduce the total brain metastases and mortality rate, so we think25Gy/1Of should still be standard treatment dose for SCLC to PCI. |
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