| Zhou yan,Ouyang Wen,Yu Jing,Gong Jun,Hu Jing,Xu Yu,Chen Gang,Gong Yan,Zhang Junhong,Xie Conghua.The effects of brain radiotherapy selection on the survival of driver gene-positive non-small cell lung cancer patients with brain metastases[J].Chinese Journal of Radiological Medicine and Protection,2020,40(5):359-364 |
| The effects of brain radiotherapy selection on the survival of driver gene-positive non-small cell lung cancer patients with brain metastases |
| Received:October 16, 2019 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.05.006 |
| KeyWords:Non-small cell lung cancer Epidermal growth factor receptor mutations Brain metastasis Tyrosine kinase inhibitors Radiotherapy |
| FundProject:国家自然科学基金（81773236） |
| Author Name | Affiliation | E-mail | | Zhou yan | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Ouyang Wen | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Yu Jing | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Gong Jun | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Hu Jing | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Xu Yu | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Chen Gang | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Gong Yan | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Zhang Junhong | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | | | Xie Conghua | Zhang Junhong, Xie Conghua Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan 430071, China | chxie_65@whu.edu.cn |
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| Abstract:: |
| 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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