Introduction: The role of prophylactic cranial irradiation (PCI) is controversial in patients with extensive stage small cell lung cancer. The aim of this study was to determine the impact of PCI in these patients. Methods: We performed a systematic review and meta‐analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Central Register. The primary outcome was overall survival (OS). Results: We identified five studies comprising 984 patients, of whom 448 received PCI and 536 did not receive PCI. In pooled estimates, PCI did not statistically improve OS compared with controls (hazard ratio [HR] = 0.82; 95% confidence interval [CI]: 0.60–1.11; I2 = 77%; p = 0.19). However, the PCI group had a significant advantage in 1‐year survival compared to the no‐PCI group (37.1% versus 27.1%; risk ratio = 0.87; 95% CI: 0.80–0.95; I2 = 47%; p = 0.002), and the pooled estimates indicated that progression‐free survival and the risk of brain metastasis were associated with significant benefit in the PCI group (HR = 0.83; 95% CI: 0.70–0.98; I2 = 22%; p = 0.03; and HR = 0.34; 95% CI: 0.23–0.50; I2 = 0%; p < 0.001, respectively). Conclusions: Our findings suggest that PCI in patients with extensive stage small cell lung cancer may lead to a significant benefit in 1‐year survival, progression‐free survival, and the risk of brain metastasis, despite the lack of a significant advantage in OS.

中文翻译：

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预防性颅脑照射在广泛期小细胞肺癌患者中的作用：系统评价和荟萃分析

简介：预防性颅脑照射 (PCI) 在广泛期小细胞肺癌患者中的作用存在争议。本研究的目的是确定 PCI 对这些患者的影响。方法：我们根据系统评价和 Meta 分析的首选报告项目指南进行了系统评价和 Meta 分析。在 MEDLINE、EMBASE 和 Cochrane Central Register 中进行了系统的文献检索。主要结果是总生存期（OS）。结果：我们确定了 5 项研究，包括 984 名患者，其中 448 名接受 PCI，536 名未接受 PCI。在汇总估计中，与对照组相比，PCI 在统计学上并未改善 OS（风险比 [HR] = 0.82；95% 置信区间 [CI]：0.60–1.11；I2 = 77%；p = 0.19）。然而，与非 PCI 组相比，PCI 组在 1 年生存率方面具有显着优势（37.1% 对 27.1%；风险比 = 0.87；95% CI：0.80–0.95；I2 = 47%；p = 0.002），以及汇总估计表明，无进展生存期和脑转移风险与 PCI 组的显着获益相关（HR = 0.83；95% CI：0.70–0.98；I2 = 22%；p = 0.03；HR = 0.34 ；95% CI：0.23–0.50；I2 = 0%；分别为 p < 0.001）。结论：我们的研究结果表明，尽管 OS 缺乏显着优势，但对广泛期小细胞肺癌患者进行 PCI 可能会显着提高 1 年生存率、无进展生存率和脑转移风险。汇总估计表明，无进展生存期和脑转移风险与 PCI 组的显着获益相关（HR = 0.83；95% CI：0.70–0.98；I2 = 22%；p = 0.03；HR = 0.34；95% CI：0.23–0.50；I2 = 0%；分别为 p < 0.001）。结论：我们的研究结果表明，尽管 OS 缺乏显着优势，但对广泛期小细胞肺癌患者进行 PCI 可能会显着提高 1 年生存率、无进展生存率和脑转移风险。汇总估计表明，无进展生存期和脑转移风险与 PCI 组的显着获益相关（HR = 0.83；95% CI：0.70–0.98；I2 = 22%；p = 0.03；HR = 0.34；95% CI：0.23–0.50；I2 = 0%；分别为 p < 0.001）。结论：我们的研究结果表明，尽管 OS 缺乏显着优势，但对广泛期小细胞肺癌患者进行 PCI 可能会显着提高 1 年生存率、无进展生存率和脑转移风险。