Individual patient data meta-analysis of prophylactic cranial irradiation in locally advanced non-small cell lung cancer

Willem J A Witlox*, Bram L T Ramaekers, Benjamin Lacas, Cecile Le Pechoux, Jean-Pierre Pignon, Alexander Sun, Si-Yu Wang, Chen Hu, Mary Redman, Vincent van der Noort, Ning Li, Matthias Guckenberger, Harm van Tinteren, Harry J M Groen, Manuela A Joore, Dirk K M De Ruysscher

*Corresponding author for this work

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Abstract

Background: Prophylactic cranial irradiation (PCI) was compared to observation in several randomized trials (RCTs), and a reduction greater than 50% was shown regarding the incidence of brain metastases (BM). However, none of these studies showed an improvement of overall survival (OS), possibly related to relatively small sample sizes and short follow-up. The aim of this meta-analysis was therefore to assess the impact of PCI on long term OS for stage III non-small cell lung cancer (NSCLC) compared to observation based on the pooled updated individual patient RCT data.

Methods: Seven RCTs were eligible, and data from the four most recent trials (924 patients) could be retrieved. The log-rank observed minus expected number of events and its variance were used to calculate individual and overall pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs) with a fixed effects model. Inter-trial heterogeneity was studied using the I-2 test. In addition, the 5-year absolute survival difference between arms was calculated for all endpoints. The pre-specified toxicities were reported descriptively.

Results: The median follow-up was 97 months (74-108). Compared to observation, no statistically significant impact of PCI on OS was observed (HR 0.90 [0.76-1.07] p = 0.23, 5-year absolute difference 1.8% [-5.2-8.8]). PCI significantly prolonged progression-free survival (HR 0.77 [0.66-0.91] p = 0.002) and BM-free survival (HR 0.82 [0.69-0.97] p = 0.02). The number of patients with high-grade (>= 3) toxicity was 6.4% (21/330) for PCI.

Conclusion: No OS benefit by PCI was observed, but PCI prolonged the progression-free survival and BM-free survival at an increased risk of late memory impairment and fatigue. (C) 2021 The Author(s). Published by Elsevier B.V.

Original languageEnglish
Pages (from-to)40-47
Number of pages8
JournalRadiotherapy and Oncology
Volume158
Early online date12-Feb-2021
DOIs
Publication statusPublished - May-2021

Keywords

  • Prophylactic cranial irradiation
  • Locally advanced non-small cell lung cancer
  • Individual patient data meta-analysis
  • HIGH-RISK
  • CHEMORADIOTHERAPY
  • MULTICENTER
  • METASTASES
  • TRIAL

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