Gow Chien-Hung, Chien Chun-Ru, Chang Yih-Leong, Chiu Yueh-Hsia, Kuo Sung-Hsin, Shih Jin-Yuan, Chang Yeun-Chung, Yu Chong-Jen, Yang Chih-Hsin, Yang Pan-Chyr
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Clin Cancer Res. 2008 Jan 1;14(1):162-8. doi: 10.1158/1078-0432.CCR-07-1468.
Whole-brain radiation therapy (WBRT) has been applied to inoperable brain metastases in lung adenocarcinoma. Recently, an in vitro study showed reduced clonogenic survival of mutant epidermal growth factor receptor (EGFR) lung cancer cell lines in response to ionizing radiation compared with that of the wild type. To elucidate the role of EGFR mutations in radiation treatment, we evaluated the clinical response to WBRT and survival of lung adenocarcinoma patients with brain metastases.
This was a retrospective analysis of 63 patients with brain metastases from lung adenocarcinoma who were treated with WBRT. Demographic data, EGFR mutation status, response to WBRT, and survival data were collected. Clinical response was assessed 1 month after the start of WBRT. Univariate and logistic regression models were used to test potential predictive factors associated with clinical response. Log-rank test and Cox regression were analyzed to identify factors that affected survival.
Clinical response to WBRT was observed in 29 patients (46%), with 34 nonresponder patients (54%). Patients with EGFR mutations had higher response rates to WBRT compared with those with the wild-type (54% versus 24%; P = 0.045). Both the administration of EGFR tyrosine kinase inhibitor (P = 0.034) and EGFR mutation (P = 0.029) were independently associated with response to WBRT. In Cox regression analysis, WBRT responder (P = 0.010) and absence of extracranial metastases (P = 0.002) were associated with better survival.
Both the EGFR mutations and the administration of EGFR TKI during WBRT were independent predictors of response to WBRT in brain metastases of lung adenocarcinoma.
全脑放射治疗（WBRT）已应用于无法手术的肺腺癌脑转移患者。最近，一项体外研究表明，与野生型相比，突变型表皮生长因子受体（EGFR）肺癌细胞系对电离辐射的克隆形成存活率降低。为了阐明EGFR突变在放射治疗中的作用，我们评估了肺腺癌脑转移患者对WBRT的临床反应和生存率。
这是一项对63例接受WBRT治疗的肺腺癌脑转移患者的回顾性分析。收集了人口统计学数据、EGFR突变状态、对WBRT的反应和生存数据。在WBRT开始后1个月评估临床反应。使用单变量和逻辑回归模型来测试与临床反应相关的潜在预测因素。采用对数秩检验和Cox回归分析来确定影响生存的因素。
29例患者（46%）对WBRT有临床反应，34例无反应患者（54%）。与野生型患者相比，EGFR突变患者对WBRT的反应率更高（54%对24%；P = 0.045）。EGFR酪氨酸激酶抑制剂的使用（P = 0.034）和EGFR突变（P = 0.029）均与对WBRT的反应独立相关。在Cox回归分析中，WBRT有反应者（P = 0.010）和无颅外转移（P = 0.002）与更好的生存相关。
EGFR突变和WBRT期间EGFR TKI的使用均是肺腺癌脑转移患者对WBRT反应的独立预测因素。
