Value of early radiotherapy for EGFR mutation-positive non-small cell lung cancer with brain metastasis in the era of third-generation targeted drugs: a single center retrospective study of 85 cases
10.3760/cma.j.cn113030-20230719-00011
- VernacularTitle:EGFR突变肺癌脑转移在三代靶向药物时代的早放疗价值
- Author:
Junlan WU
1
;
Mianshun PAN
;
Zhaoming MA
;
Haitao LIU
;
Yong LI
;
Xianjun SHAO
;
Yan WEI
;
Qian YUE
Author Information
1. 武警上海总队医院肿瘤放射诊疗中心，上海 201103
- Keywords:
Carcinoma, non-small cell lung;
Brain metastasis;
Epidermal growth factor receptor mutation;
Third-generation targeted drugs;
Stereotactic radiotherapy
- From:
Chinese Journal of Radiation Oncology
2024;33(3):212-217
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the reasonable timing of radiotherapy for epidermal growth factor receptor ( EGFR) mutation-positive non-small cell lung cancer patients with brain metastasis in the era of third-generation targeted drugs. Methods:Clinical data of EGFR mutation-positive non-small cell lung cancer patients with brain metastasis who received first-line treatment with third-generation targeted drugs and stereotactic radiotherapy at Shanghai Armed Police Corps Hospital from September 2019 to May 2022 were retrospectively analyzed. According to the timing of radiotherapy before / after targeted drug resistance, all patients were divided into the early and salvage radiotherapy groups. The proportion of brain metastasis, physical fitness, complete response rate, objective response rate, delaying the progression of brain metastasis and overall survival (OS) were compared between two groups. Kaplan-Meier method was used for survival analysis, log-rank test was used for univariate prognostic analysis, and factors with P <0.1 were included in Cox multivariate analysis. Results:A total of 85 patients were included, including 51 (60%) cases receiving early radiotherapy. Patients who participated in early radiotherapy had a higher proportion of symptomatic brain metastasis (82% vs. 56%, P=0.013) and poorer physical fitness (Kanofsky performance score <70: 61% vs. 26%, P=0.002) compared to patients who underwent salvage radiotherapy. Early radiotherapy significantly improved the complete response rate of intracranial lesions (35% vs. 12%, P=0.015) and objective response rate (88% vs. 71%, P=0.041), delayed the progression of brain metastasis (median intracranial progression free survival: 23.0 months vs. 16.0 months, P=0.005; median intracranial secondary progression free survival: 31.0 months vs. 22.0 months, P=0.021), and improved OS (median OS: 44.0 months vs. 35.0 months, P=0.046). In multivariate analysis, diagnosis-specific graded prognostic assessment score <2.5, mutation of EGFR exon 21, and salvage brain radiotherapy were adverse prognostic factors for OS. Conclusion:In the era of third-generation targeted drugs therapy, early involvement of stereotactic radiotherapy in non-small cell lung cancer patients with brain metastasis can bring greater clinical benefits.
