NSCLC: reduced brain metastases with PCI, but no OS benefit

  • Liu L & al.
  • Front Oncol
  • 1 Jan 2020

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Prophylactic cranial irradiation (PCI) is associated with a significantly lower incidence of brain metastases in patients with NSCLC, especially in patients with good performance status, but offers no survival benefit.

Why this matters

  • Although earlier studies suggested an association of PCI with significantly decreased incidence of brain metastases, data on the survival benefit have been conflicting.

Study design

  • Meta-analysis of 7 studies with 1462 patients with NSCLC who received PCI (n=717) or no PCI (n=745).
  • Funding: National Natural Science Foundation of China.

Key results

  • Receipt of PCI was associated with a significantly lower incidence of brain metastases:
    • Relative risk, 0.37 (95% CI, 0.26-0.52).
  • Receipt of PCI was not associated with improved OS:
    • Pooled HR, 1.01 (95% CI, 0.87-1.22).
  • PCI was associated with a significant decrease in brain metastases in patients with good performance status:
    • HR, 0.21 (95% CI, 0.10-0.47).
  • PCI-related toxicities and adverse events were considered minor and included alopecia, headache, fatigue, skin toxicity, nausea, and vomiting.
  • 1 study reported a high incidence of cognitive impairment, but there were no reports of negative QoL resulting from PCI-related adverse events.

Limitations

  • Retrospective study with potential risk bias.