Qin Hong, Pan Feng, Li Jianjun, Zhang Xiaoli, Liang Houjie, Ruan Zhihua
Department of Oncology, Southwest Hospital, the Third Military Medical University, Chongqing, PR China.
PLoS One. 2014 Oct 27;9(10):e111475. doi: 10.1371/journal.pone.0111475. eCollection 2014.
The aim of the present meta-analysis is to evaluate the response rate, median survival time (MST) and toxicity in patients with brain metastases (BM) originating from non-small cell lung cancer (NSCLC) and who were treated using either whole brain radiotherapy (WBRT) plus concurrent chemotherapy or WBRT alone.
PubMed, EMBASE, Web of Science, The Cochrane Library, clinical trials and current controlled trials were searched to identify any relevant publications. After screening the literature and undertaking quality assessment and data extraction, the meta-analysis was performed using Stata11.0 software.
In total, six randomized controlled trials (RCT) involving 910 participants were included in the meta-analysis. The results of the analysis indicate that WBRT plus concurrent chemotherapy was more effective at improving response rate (RR = 2.06, 95% CI [1.13, 3.77]; P = 0.019) than WBRT alone. However, WBRT plus concurrent chemotherapy did not improve median survival time (MST) (HR = 1.09, 95%CI [0.94, 1.26]; P = 0.233) or time of neurological progression (CNS-TTP) (HR = 0.93, 95%CI [0.75, 1.16]; P = 0.543), and increased adverse events (Grade≥3) (RR = 2.59, 95% CI [1.88, 3.58]; P = 0.000). There were no significant differences in Grade 3-5 neurological or hematological toxicity between two patient groups (RR = 1.08, 95%CI [0.23, 5.1]; P = 0.92).
The combination of chemotherapy plus WBRT in patients with BM originating from NSCLC may increase treatment response rates of brain metastases with limited toxicity. Although the therapy schedule did not prolong MST or CNS-TTP, further assessment is warranted.
本荟萃分析旨在评估源于非小细胞肺癌（NSCLC）的脑转移瘤（BM）患者采用全脑放疗（WBRT）联合同步化疗或单纯WBRT治疗后的缓解率、中位生存时间（MST）和毒性。
检索PubMed、EMBASE、科学网、考克兰图书馆、临床试验和当前对照试验，以识别任何相关出版物。在筛选文献、进行质量评估和数据提取后，使用Stata11.0软件进行荟萃分析。
荟萃分析共纳入6项随机对照试验（RCT），涉及910名参与者。分析结果表明，WBRT联合同步化疗在提高缓解率方面（RR = 2.06，95%CI[1.13，3.77]；P = 0.019）比单纯WBRT更有效。然而，WBRT联合同步化疗并未改善中位生存时间（MST）（HR = 1.09，95%CI[0.94，1.26]；P = 0.233）或神经学进展时间（CNS-TTP）（HR = 0.93，95%CI[0.75，1.16]；P = 0.543），且增加了不良事件（≥3级）（RR = 2.59，95%CI[1.88，3.58]；P = 0.000）。两组患者在3-5级神经学或血液学毒性方面无显著差异（RR = 1.08，95%CI[0.23，5.1]；P = 0.92）。
对于源于NSCLC的BM患者，化疗联合WBRT可能会提高脑转移瘤的治疗缓解率，且毒性有限。尽管该治疗方案未延长MST或CNS-TTP，但仍需进一步评估。
