| 周燕,欧阳雯,余静,龚俊,胡静,徐禹,陈刚,龚,张俊红,谢丛华.脑部放疗的选择对驱动基因阳性非小细胞肺癌脑转移患者生存的影响[J].中华放射医学与防护杂志,2020,40(5):359-364 |
| 脑部放疗的选择对驱动基因阳性非小细胞肺癌脑转移患者生存的影响 |
| The effects of brain radiotherapy selection on the survival of driver gene-positive non-small cell lung cancer patients with brain metastases |
| 投稿时间：2019-10-16 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.05.006 |
| 中文关键词: 非小细胞肺癌 表皮生长因子受体 脑转移 酪氨酸激酶抑制剂 放疗 |
| 英文关键词:Non-small cell lung cancer Epidermal growth factor receptor mutations Brain metastasis Tyrosine kinase inhibitors Radiotherapy |
| 基金项目:国家自然科学基金（81773236） |
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| 中文摘要: |
| 目的 探讨在既往未使用过酪氨酸激酶抑制剂（TKI）的表皮生长因子受体（EGFR）突变的非小细胞肺癌脑转移患者中，脑放疗介入的时间及脑放疗方式的选择。方法 回顾性分析武汉大学中南医院放化疗科2014年1月至2018年9月收治的69例合并脑转移的EGFR突变的非小细胞肺癌（NSCLC）患者，根据脑部放疗介入时间将患者分为两组：早放疗组（45例）即确诊脑转移后先行脑部放疗并接受TKI药物治疗，晚放疗组（24例）即先使用TKI药物至出现脑转移病灶进展后行脑放疗，早放疗组根据脑放疗方式可分为早全脑放射治疗（WBRT）组（20例），早立体定向放射外科（SRS）组（25例），比较患者的总生存（OS）、颅内无进展生存（iPFS）及无进展生存（PFS）。结果 入组69例患者的中位OS为31.2个月，早放疗组与晚放疗组1年和2年OS分别为95%、64%和80%、35%，两组差异有统计学意义（χ2=8.87，P<0.05）。进一步分析显示，早WBRT组、早SRS组及晚放疗组1年和2年OS分别为95%、96%、80%和 42%、88%、35%（χ2=12.01，P<0.05）。早SRS组较晚放疗组有OS获益（HR：0.10，95%CI：0.23~0.46，P=0.003），而早WBRT组较晚放疗组OS未见显著获益（HR：0.54，95%CI：0.21~1.32，P=0.180）。早放疗组与晚放疗组iPFS及PFS比较差异均无统计学意义（P>0.05）。结论 对于既往未接受TKI药物治疗的EGFR突变的NSCLC脑转移患者，尽早脑部放疗介入有助于延长患者生存期，其中使用SRS较使用WBRT获益明显。 |
| 英文摘要: |
| Objective To explore the appropriate radiotherapy time and method in the treatment of patients with brain metastases (BM) due to from non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation. Methods Totally 69 EGFR-mutant NSCLC patients with BM treated in Zhongnan Hospital of Wuhan University from January 2014 to September 2018 were retrospectively reviewed. The patients were divided into two groups according to the time of brain radiotherapy, including the upfront radiotherapy group (n=45) who received concurrent brain radiotherapy and EGFR-tyrosine kinase inhibitors(TKI)treatments and deferred radiotherapy group (n=24) who received brain radiotherapy after intracranial progression during EGFR-TKI treatment. The upfront radiotherapy group was further divided into two groups, the group treated with WBRT concurrent with EGFR-TKI (n=20) and the group treated with SRS concurrent with EGFR-TKI (n=25). Overall survival (OS), progression-free survival (PFS) and intracranial progression-free survival (iPFS) time were evaluated. Results The median OS of 69 patients was 31.2 months. For the upfront and deferred radiotherapy groups, the 1-, 2- year OS were 95%, 64% and 80%, 35%, the difference between the two groups was statistically significant. On subgroup analysis, the upfront WBRT, upfront SRS and deferred radiotherapy groups 1-,2- year OS were 95%, 96%, 80% and 42%, 88%, 35%. Moreover, the upfront SRS group was associated with improved OS relative to the deferred radiotherapy group (HR:0.10, 95%CI:0.23-0.46, P=0.003), but the upfront WBRT and deferred radiotherapy groups shared similar OS (HR:0.54,95%CI:0.21-1.32, P=0.180). There were no significant difference in iPFS and PFS between the upfront and deferred radiotherapy groups(P>0.05). Conclusions Upfront brain radiotherapy prolonged the survival of BM patients metastasized from EGFR-mutant NSCLC. SRS concurrent with EGFR-TKI may be superior to WBRT concurrent with EGFR-TKI in the treatment of BM metastasized from EGFR-mutant NSCLC. |
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