Lin Ching-Heng, Hsu Kuo-Hsuan, Chang Shih-Ni, Tsou Hsi-Kai, Sheehan Jason, Sheu Meei-Ling, Pan Hung-Chuan
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Radiat Oncol. 2015 Jun 6;10:127. doi: 10.1186/s13014-015-0431-7.
Whole brain irradiation (WBRT) either with or without resection has historically been the treatment for brain metastases from non-small cell lung cancer (NSCLC). The effect of gamma knife (GK) radiosurgery, chemotherapy, or the combination remains incompletely defined. In this study, we assessed the outcome of brain metastases from non-small cell lung cancer treated by WBRT followed by GK, gefitinib, or the combination of GK and gefitinib.
We retrieved the records of NSCLC patients with brain metastases from the National Health Insurance Research Database (NHIRD) of Taiwan from 2004 to 2010. WBRT either with or without resection was the first line treatment for nearly all patients. The decision to add GK and/or gefitinib treatment was at the discretion of the treating physician and based upon a patient's medical records and imaging data. These patients were classified into four groups including WBRT, WBRT + gefitinib, WBRT + GK, WBRT + gefitinib + GK. These data was evaluated for difference in survival and factors that portended an extended survival from the time of brain metastasis diagnosis.
Of the 60194 patients with newly diagnosed NSCLC, 23874 (39.6 %) developed brain metastases. The distribution of patients for the groups was WBRT for 20241, WBRT + gefitinib for 3379, WBRT + GK for 155, and WBRT+ gefitinib + GK for 99 patients. The median survival for the time of brain metastasis diagnosis for WBRT, WBRT+ gefitinib, WBRT+ GK, WBRT+ gefitinib + GK groups was 0.53, 1.01, 1.46, and 2.25 years, respectively (p < 0.0001). The hazard ratio (95 % CI) for survival was 1, 0.56, 0.43, and 0.40, respectively (p < 0.001). The adjusted hazard ratio (95 % CI) by age, sex and Charlson comorbidity index (CCI) was 1, 0.73, 0.49, and 0.42, respectively (p < 0.001).
Patients with brain metastases from NSCLC receiving GK or gefitinib demonstrated extended survival. The improved survival seen with GK and gefitinib suggests a survival benefit in selected patients receiving the combined treatment. Further Phase II study should be conducted to assessment these influence.
全脑放疗（WBRT）无论是否联合手术切除，一直以来都是非小细胞肺癌（NSCLC）脑转移的治疗方法。伽玛刀（GK）放射外科、化疗或联合治疗的效果仍未完全明确。在本研究中，我们评估了接受WBRT后再接受GK、吉非替尼或GK与吉非替尼联合治疗的NSCLC脑转移患者的预后。
我们从台湾国民健康保险研究数据库（NHIRD）中检索了2004年至2010年NSCLC脑转移患者的记录。几乎所有患者的一线治疗都是WBRT无论是否联合手术切除。是否添加GK和/或吉非替尼治疗由主治医生根据患者的病历和影像数据自行决定。这些患者被分为四组，包括WBRT组、WBRT +吉非替尼组、WBRT + GK组、WBRT+吉非替尼 + GK组。评估这些数据在生存方面的差异以及从脑转移诊断时起预示生存期延长的因素。
在60194例新诊断的NSCLC患者中，23874例（39.6%）发生了脑转移。各组患者的分布情况为：WBRT组20241例，WBRT +吉非替尼组3379例，WBRT + GK组155例，WBRT+吉非替尼 + GK组99例。WBRT组、WBRT+吉非替尼组、WBRT+ GK组、WBRT+吉非替尼 + GK组从脑转移诊断时起的中位生存期分别为0.53年、1.01年、1.46年和2.25年（p < 0.0001）。生存的风险比（95%CI）分别为1、0.56、0.43和0.40（p < 0.001）。根据年龄、性别和查尔森合并症指数（CCI）调整后的风险比（95%CI）分别为1、0.73、0.49和0.42（p < 0.001）。
接受GK或吉非替尼治疗的NSCLC脑转移患者生存期延长。GK和吉非替尼观察到的生存期改善表明在接受联合治疗的特定患者中有生存获益。应进行进一步的II期研究来评估这些影响。
