Survival and intracranial control outcomes of whole-brain radiotherapy (WBRT) alone versus WBRT plus a radiotherapy boost in non-small-cell lung cancer with brain metastases: a single-institution retrospective analysis
Survival and intracranial control outcomes of whole-brain radiotherapy (WBRT) alone versus WBRT plus a radiotherapy boost in non-small-cell lung cancer with brain metastases: a single-institution retrospective analysis
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单独全脑放疗 (WBRT) 与 WBRT 加放疗加强对非小细胞肺癌脑转移患者的生存和颅内控制结果：单机构回顾性分析
DOI：
10.2147/cmar.s203461
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Li, Wenhui
中科院分区：
文献类型：
--
作者：
Lu, Fei;Hou, Yu;Li, Wenhui
目的：比较非小细胞肺癌(NSCLC)合并脑转移(BMS)患者接受全脑放疗(WBRT)和全脑放疗加放疗(RTB)后的生存率和颅内局部控制率的差异。方法：2010年5月至2017年10月，206例非小细胞肺癌BMS患者接受脑放疗，其中单纯放疗组(A组)140例，放疗组(B组)66例。研究终点包括颅内局部无进展生存期和局部无进展生存期(分别为iLPFS和irPFS)和总生存期(OS)。结果：在两组之间，并不是所有基线临床因素都是平衡的。A组2年iLPFS发生率为34.5%，明显低于B组的49.3%(P=0.041)，而OS和iLPFS两组间差异无统计学意义。多因素分析显示，表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)治疗与良好的OS、iLPFS和irPFS显著相关。在接受TKI治疗的62例患者中，A、B两组间的OS(P=0.190)、iLPFS(P=0.334)和iLPFS(P=0.338)差异无统计学意义。结论：与单纯WBRT相比，WBRT加RTB能显著改善iLPFS，尤其是在未接受EGFR-TKI治疗的患者中。然而，两组患者的irPFS和OS差异无统计学意义。接受EGFR-TKIs治疗的患者可能无法从WBRT加RTB中受益。
Purpose: To compare the differences in survival and intracranial local control between patients treated with whole-brain radiotherapy (WBRT) and WBRT plus a radiotherapy boost (RTB) in non-small-cell lung cancer (NSCLC) patients with brain metastases (BMs). Patients and methods: Between May 2010 and October 2017, 206 NSCLC patients with BMs were treated with brain radiotherapy; among these patients, 140 patients underwent WBRT alone (group A) and 66 patients underwent WBRT plus RTB (group B). The endpoints included intracranial local progression-free survival and regional progression-free survival time (iLPFS and iRPFS, respectively) and overall survival (OS). Results: Between the two groups, not all baseline clinical factors were well-balanced. The median iLPFS was 17.9 months in group A and 22.3 months in group B. The 2-year iLPFS rates were significantly lower in group A than in group B (34.5% vs 49.3%, P=0.041); however, no significant differences were observed in OS or iRPFS. Multivariate analyses revealed that epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) therapy was significantly associated with good OS, iLPFS, and iRPFS. Among the patients treated with TKIs (n=62), there were no differences in OS (P=0.190), iLPFS (P=0.334), or iRPFS (P=0.338) between groups A and B. In the patients without TKI treatment (n=102), the median iLPFS was significantly longer in group B than in group A (16.7 vs 12.0 months, P=0.032), but no significant differences were found in OS (p=0.182) or iRPFS (P=0.837) between the two groups. Conclusion: WBRT plus RTB significantly improved iLPFS compared with WBRT alone, especially in patients without EGFR-TKI treatment. However,there were no significant differences in iRPFS or OS between the two groups. Patients treated with EGFR-TKIs may not benefit from WBRT plus RTB.