Efficacy of brain radiotherapy plus EGFR-TKI for EGFR-mutated non-small cell lung cancer patients who develop brain metastasis.
Efficacy of brain radiotherapy plus EGFR-TKI for EGFR-mutated non-small cell lung cancer patients who develop brain metastasis.
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DOI：
10.5114/aoms.2018.78939
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发表时间：
2018-10
期刊：
影响因子：
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通讯作者：
Zhang Y
中科院分区：
文献类型：
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作者：
Wang W;Song Z;Zhang Y
分析表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）和脑放射治疗（RT）治疗EGFR突变非小细胞肺癌（NSCLC）患者的症状性和无症状性脑转移（BM）的适当治疗方法或时机。我们回顾性研究了2006年6月至2015年12月在浙江省肿瘤医院诊断为EGFR基因突变的NSCLC患者，这些患者发生脑转移。回顾性评估了181例患者（49例症状性BM和132例无症状BM）的治疗数据。在49例症状性BM患者中，立体定向放射外科（SRS）治疗组的中位OS长于全脑放疗（WBRT）组（37.7 vs. 21.1个月）（p = 0.194）。在132例无症状脑转移患者组中，前期脑放疗组的中位总生存期（mOS）长于前期TKI组（24.9 vs. 17.4个月）（p = 0.035）。在关于使用放疗时间的进一步分析中，在所有74例患者中，33例同时接受TKI和脑放疗，13例在一线RT治疗后接受TKI，28例在TKI失败后接受放疗。三组的颅内无进展生存期（iPFS）分别为11.1个月、11.3个月和8.1个月（p = 0.032）。三组的mOS分别为21.9个月、26.2个月和17.1个月（p = 0.085）。我们的研究表明，延迟脑RT可能导致EGFR突变NSCLC无症状脑转移患者的iPFS较差，但未获得OS获益。此外，我们的研究显示，接受SRS治疗的患者症状性BM的OS显著延长。未来迫切需要对该患者队列进行WBRT或SRS和TKI的最佳管理策略的前瞻性研究。
To analyze the appropriate treatment methods or timing to use epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and brain radiation treatment (RT) for symptomatic and asymptomatic brain metastases (BM) in patients with EGFR mutation non-small cell lung cancer (NSCLC). We retrospectively studied patients diagnosed with EGFR gene mutated NSCLC who developed brain metastasis between June 2006 and December 2015 at Zhejiang Cancer Hospital. Treatment data were assessed in 181 patients with 49 symptomatic BM and 132 asymptomatic BM retrospectively. In 49 symptomatic BM patients, the median OS of the stereotactic radiosurgery (SRS)-treated group was longer than in the whole brain radiotherapy (WBRT) group (37.7 vs. 21.1 months) (p = 0.194). In the group of 132 asymptomatic brain metastasis patients, the median overall survival (mOS) was longer in upfront brain radiotherapy compared with the upfront TKI group (24.9 vs. 17.4 months) (p = 0.035). In further analysis regarding the timing of using radiotherapy, out of all 74 patients, 33 underwent concurrent TKI and brain radiation, 13 received TKI after first-line RT treatment and 28 patients received radiotherapy after TKI failure. The intracranial progression free survival (iPFS) of the three groups was 11.1 months, 11.3 months and 8.1 months (p = 0.032), respectively. The mOS of the three groups was 21.9 months, 26.2 months and 17.1 months, respectively (p = 0.085). Our research indicated that delayed brain RT may result in inferior iPFS in EGFR mutated NSCLC patients with asymptomatic brain metastases, but no OS benefit was obtained. In addition, our study revealed that patients treated with SRS had a significantly longer OS for symptomatic BM. Future prospective study of the optimal management strategy with WBRT or SRS and TKI for this patient cohort is urgently needed.
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对于 NSCLC 和 EGFR 突变和脑转移患者，EGFR TKI 联合 WBRT 与单独使用 TKI 相比没有任何生存获益
影响因子：
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DOI：
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发表时间：
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影响因子：
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DOI：
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发表时间：
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期刊：
Nature reviews. Clinical oncology
影响因子：
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作者：
通讯作者：
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