title: Prophylactic cranial irradiation may impose a detrimental effect on overall survival of patients with nonsmall cell lung cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the role of brain metastases (BM) and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) by performing a meta-analysis of the RCTs (randomized controlled clinical trials) and non-RCTs (non-randomized controlled clinical trials) published in the literature.
  
  
  METHODS
  A meta-analysis was performed using trials identified through PubMed, EMBASE and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included BM, OS, median survival (MS), response rate (RR), Hazard ratios (HRs) and odds ratios (ORs), and their 95% confidence intervals (CIs) were pooled using ReMan software.
  
  
  RESULTS
  Twelve trials (6 RCTs and 6 non-RCTs) involving 1,718 NSCLC patients met the inclusion criteria. They were grouped on the basis of study design for separate Meta-analyses. The results showed that prophylactic cranial irradiation (PCI) reduced the risk of BM as compared with non-PCI in NSCLC patients (OR = 0.30, 95% [CI]: 0.21-0.43, p<0.00001). However, HRs for OS favored non-PCI (HR = 1.19, 95% [CI]: 1.06-1.33, p = 0.004), without evidence of heterogeneity between the studies.
  
  
  CONCLUSIONS
  Our results suggest that although PCI decreased the risk of BM, it may impose a detrimental effect on OS of NSCLC patients.
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, Peoples R China.
authors: Shuan-shuan
authors: SS
authors: Xie
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, Peoples R China.
authors: Ming
authors: M
authors: Li
authors: Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Cancer Institute, Shanghai, Peoples R China.
authors: Cai-cun
authors: CC
authors: Zhou
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, Peoples R China.
authors: Xiao-lian
authors: XL
authors: Song
authors: Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, Peoples R China.
authors: Chang-hui
authors: CH
authors: Wang
mesh_terms: D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology*; D016022:Case-Control Studies; D016371:Cranial Irradiation; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology*; D065228:Non-Randomized Controlled Trials as Topic; D016017:Odds Ratio; D011292:Premedication; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic