Objective: To evaluate the clinical value and optimal therapeutic dose of prophylactic cranial irradia-tion( PCI )in patients with small cell lung cancer( SCLC )in complete remission. Methods: We searched PubMed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database, China Journal Full Text Database, and Wan-fang Database. All the relevant randomized controlled trials was collected, and the quality of the included trials was assessed. Meta - analyses were conducted by RevMan 5.0 software. Results: Fifteen studies were involved and 2233 patients were included. Meta - analysis showed that : there was significant difference inl-,2-,3-,5- year survival rates [ OR = 1. 51,95% CI( 1.14 -2.01 ), OR = 1.77,95%CI( 1.33-2.35 ), OR = 1. 57,95% CI( 1.09 -2. 25 ) ], disease - free survival rate [ OR = 2. 43 ,95% CI( 1. 76 - 3. 34 ) ] , brain metastases rate [ OR = 0. 29 , 95 % CI( 0. 19 -0. 46 ) ], other transfer rate [ OR =0. 59,95% CI( 0. 43 -0. 80 ) ] between PCI group and no - PCI group. But there was no significant difference in local recurrence rate [ OR =0. 89,95% CI( 0. 66 - 1. 21 ) ] between PCI group and no - PCI group. To compared with higher - dose group, the standard - dose group can increase 1 - year overall survival OR = 1. 43 ,95% CI( 1. 07 - 1. 92 ) ] and 1 - year disease - free survival OR = 1. 43 ,95% CI ( 1.05 - 1. 95 ) ], and 2 - year overall survival, 3 - year overall survival, 2 - year disease - free survival, 3 - year disease - free survival had no difference between standard - dose group and high - dose group, but 1 - year brain metastases rate was higher than high - dose group. Conclusion: PCI can improve the overall survival rate and disease - free survival rate, at the same time, reduce brain metastases and other transfer rate in patients with small cell lung cancer. So it can be used as a kind of small cell lung cancer prevention and treatment method. The high - dose PCI group did not significantly reduce the total brain metastases and mortality rate, so we think 25Gy PCI still should be standard treatment dose for SCLC.%目的 系统评价预防性颅脑照射(PCI)在完全缓解(CR)的小细胞肺癌(SCLC)中应用的临床价值及最佳治疗剂量.方法 计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库,同时从参考文献中追溯查找.收集国内外有关的随机对照实验(RCT),评价纳入文献的方法学质量,并利用RevMan5.0软件进行Meta分析.结果 共纳入15个研究(2233例),其中13个RCT为行PCI与不行PCI(no-PCI)的对照,2个RCT为标准剂量(25Gy)与较高剂量(36Gy)的对照.Meta分析结果显示:相对于no-PCI组,PCI 可提高SCLC患者的 1、3、5年生存率[OR=1.51,95%CI（1.14-2.01）、OR=1.77,95%CI(1.33-2.35)、OR=1.57,95%CI(1.09-2.25)）和无瘤生存率［OR=2.43,95%CI(1.76-3.34)］,降低脑转移率［OR=0.29,95%CI（0.19-0.46））和其他转移率［OR=0.59,95%CI(0.43-0.80)］,而在局部区域复发率［OR=0.89,95%CI（0.66-1.21））方面无差异；与较高剂量组相比,标准剂量组可提高SCLC患者的1年生存率［OR=1.43,95%CI(1.07-1.92)］和1年无瘤生存率［OR=1.43,95%CI(1.05-1.95)］,在改善SCLC患者的2年生存率［OR=1.23,95%CI(0.91-1.66)］、3年生存率［OR=1.29,95%CI(0.94-1.76)］、2年无瘤生存率［OR=1.22,95%CI(0.89-1.67)］、3年无瘤生存率［OR=1.22,95%CI(0.88-1.70)］[KG（*8）方面无差异,但在1年脑转移发生率［OR=[KG]]1.74,95%CI（1.16-2.60））方面要高于较高剂量组.〖HT5"H〗结论 在经化疗和放射治疗后完全缓解的SCLC患者中,PCI能提高总生存率和无瘤生存率,并能降低脑转移及其他远处转移率,可作为一种有效的预防治疗手段.较高剂量PCI组并不能显著降低脑转移总发生率和死亡率,故认为25Gy的PCI是标准治疗剂量.
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