Thoracic Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China.
Medicine (Baltimore). 2023 Sep 8;102(36):e34572. doi: 10.1097/MD.0000000000034572.
Currently, the therapies for brain metastases of non-small cell lung cancer (NSCLC) mainly include whole brain radiotherapy and icotinib. For exploring the efficacy and safety of radiotherapy and icotinib, a meta-analysis was performed based on a series of data.
A systematic search was performed on PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure and Wanfang Database. The search time was set from the database establishment to December, 2022. All randomized controlled trials evaluating the efficacy and safety of whole brain radiotherapy alone or in combination with icotinib for whole brain metastases of NSCLC were included in our meta-analysis. Clinical outcomes and adverse reactions were analyzed using Stata17.0 software.
Finally, 10 clinical studies were enrolled in this meta-analysis, including 717 patients. Briefly, compared with radiotherapy alone, icotinib combined with radiotherapy increased response rate [relative ratio (RR) = 1.240; 95% confidence interval (CI) (1.141, 1.348); P < .001] and disease control rate (RR = 1.240, 95% CI [1.141,1.348], P < .001). Besides, according to the outcomes of adverse reaction assessment exhibited, there were no significant differences between the 2 group patients in the incidence of rash (RR = 1.536, 95% CI [0.694, 3.402], P = .290), adverse reaction in gastrointestinal tract (RR = 1.060, 95% CI [0.792, 1.419], P = 1.419), hepatic injury (RR = 1.541, 95% CI [0.798,2.975], P = .198) and leukopenia (RR = 1.182, 95% CI [0.787, 1.777], P = .421). However, the patients receiving combination treatment showed much longer progression free survival than those receiving radiotherapy alone (standardized mean difference = 1.559; 95% CI [0.699, 2.419]; P < .001).
Icotinib combined with radiotherapy can significantly short-term and long-term efficacy of NSCLC patients with brain metastases but not increase adverse reactions.
目前，非小细胞肺癌脑转移的治疗方法主要包括全脑放疗和伊可替尼。为了探索放疗和伊可替尼的疗效和安全性，我们进行了一项基于一系列数据的荟萃分析。
我们在 PubMed、Web of Science、Cochrane 图书馆、中国知网和万方数据库中进行了系统检索。检索时间设定为数据库建立至 2022 年 12 月。我们将所有评估全脑放疗单独或联合伊可替尼治疗非小细胞肺癌脑转移疗效和安全性的随机对照试验纳入荟萃分析。使用 Stata17.0 软件分析临床结局和不良反应。
最终，本荟萃分析纳入了 10 项临床研究，共 717 例患者。简而言之，与单纯放疗相比，伊可替尼联合放疗可提高缓解率[相对比（RR）=1.240；95%置信区间（CI）（1.141，1.348）；P<0.001]和疾病控制率（RR=1.240，95%CI[1.141，1.348]，P<0.001）。此外，根据不良反应评估结果，两组患者皮疹（RR=1.536，95%CI[0.694，3.402]，P=0.290）、胃肠道不良反应（RR=1.060，95%CI[0.792，1.419]，P=1.419）、肝损伤（RR=1.541，95%CI[0.798，2.975]，P=0.198）和白细胞减少症（RR=1.182，95%CI[0.787，1.777]，P=0.421）的发生率无显著差异。然而，接受联合治疗的患者无进展生存期明显长于单纯放疗组（标准化均数差=1.559；95%CI[0.699，2.419]；P<0.001）。
伊可替尼联合放疗可显著提高非小细胞肺癌脑转移患者的近期和远期疗效，但不增加不良反应。
