Whole Brain Radiotherapy Plus Chemotherapy in the Treatment of Brain Metastases from Lung Cancer: A Metaanalysis of 19 Randomized Controlled Trails

Objective: To evaluate the efficacy and safety of whole brain radiotherapy (WBRT) plus chemotherapyversus WBRT alone for treating brain metastases (BM) from lung cancer by performing a meta-analysis basedon randomized controlled trials (RCTs).
Methods: The PubMed, Embase, CENTRAL, ASCO, ESMO, CBM,CNKI, and VIP databases were searched for relevant RCTs performed between January 2000 and March 2012.After quality assessment and data extraction, the meta-analysis was performed using the RevMan 5.1 software,with funnel plot evaluation of publication bias.
Results: 19 RCTs involving 1,343 patients were included. Themeta-analyses demonstrated that compared to WBRT alone, WBRT plus chemotherapy was more effective withregard to the objective response rate (OR = 2.30, 95% CI = 1.79 – 2.98; P < 0.001); however, the incidences ofgastrointestinal reactions (RR = 3.82, 95% CI = 2.33 - 6.28, P <0.001), bone marrow suppression (RR = 5.49,95% CI = 3.65 - 8.25, P < 0.001), thrombocytopenia (RR = 5.83, 95% CI = 0.39 - 86.59; P = 0.20), leukopenia(RR = 3.13, 95% CI = 1.77 – 5.51; P < 0.001), and neutropenia (RR = 2.75, 95% CI = 1.61 - 4.68; P < 0.001) inpatients treated with WBRT plus chemotherapy were higher than with WBRT alone. There was no obviouspublication bias detected.
Conclusion: WBRT plus chemotherapy can obviously improve total efficacy rate,butalso increases the incidence of adverse reactions compared to WBRT alone. From the limitations of thisstudy, more large-scale, high-quality RCTs are suggested for further verification.