Meta-analysis of efficiency and safety of WBRT±temozolomide in treatment of brain metastases from NSCLC / 中华放射肿瘤学杂志

ABSTRACT

Objective To compare the efficacy and safety between whole brain radiotherapy (WBRT) and WBRT combined with temozolomide (TMZ) in the treatment of non-small cell lung cancer with brain metastases.Methods According to the retrieval strategy,the Chinese and English literatures before February 2018 were retrieved from EMbase,Cochrane,PubMed,Wanfang database,Chongqing VIP and CNKI,The target literatures were selected according to the inclusion and exclusion criteria,The quality of the included studies and extracted data was independently assessed by 3 researchers,The RevMan 5,3 and STATA 12,0 software was used for statistical analysis,The objective remission rate (ORR),the total survival period (OS),the progression-free survival (PFS),and the side effects of chemotherapy were evaluated.Results In total,17 trials consisting of 1128 patients were included,The results of Meta-analysis demonstrated that compared with the WBRT group,the ORR was significantly higher (OR=2.54;95％CI:1.93-3.36;P＜0.001),the PFS was significantly longer (MS R=1.329;95％CI:1.143-1.545;P＜0,001),and the incidence of hematological toxicity (OR=3.44;95％CI:1.63-7.26;P＜ 0.05) and the gastric intestinal reaction (OR=1.69;95％CI:1.24-2.31;P＜0.05) was significantly higher in the WBRT+TMZ group,The heterogeneities were within the acceptable range with statistical significance,The results of OS were invalid due to relatively large heterogeneity,The incidence of headache did not significantly differ between two groups (OR=1.05;95％CI:0.72-1.55;P=0,79).Conclusions Compared with WBRT alone,WBRT combined with TMZ is beneficial to improve the short-term efficacy,whereas the incidence of hematological toxicity and gastrointestinal reaction is higher,The occurrence of headache does not significantly differ between two groups,The benefit of long-term survival remains uncertain.