Cai Linbo, Qiu Xiaoguang, Yang Haihong, Lai Mingyao, Shan Changguo, Hong Weiping, Li Juan, Luo Longhui, Zhang Ping, Wang Lichao
Department of oncology, Guangdong 999 Brain Hospital, Guangzhou, China.
Department of neurosurgery of Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Oncotarget. 2016 Jul 6;8(34):57470-57476. doi: 10.18632/oncotarget.10420. eCollection 2017 Aug 22.
Stereotactic radiosurgery (SRS) is a widely used therapy for brain metastases(BMs) in Non-small cell lung cancer(NSCLC). However, its role in symptomatic patients with EGFR mutation remains unclear. We have retrospectively reviewed the clinical data of patients with symptomatic BMs whom received SRS as a salvage approach and concurrent gifitinib therapy.
Seven patients with primary NSCLC, symptomatic BMs, and EGFR mutation were identified in a retrospective review of patients treated with SRS using X-knife at Guangdong 999 Brain Hospital between 1 January 2012 and 31 August 2014. The median follow-up of these patients was 16 months. Image fusion technique was used to determine cumulative doses to targeted lesions, whole brain, and critical brain structures. Toxicities and complications were identified by clinical records.
SRS(X-knife) was selected to be performed on seven patients (two males and five females) diagnosed with NSCLC and EGFR mutation due to the presence of encephaledema, compression of ventricles, or other complications. Neurological symptoms (such as paresis, aphasia, sensory and visual disturbances) were not present in any patients before or after SRS treatment, and the postoperative Karnofsky performance status(KPS) was improved in all patients. Median overall survival(OS) was 16 months and median progression free survival(PFS) was 10 months.
The improvement of KPS and survival were reliable by SRS(X-knife) with concurrent gifitinib therapy in NSCLC patients with symptomatic BMs, and EGFR mutation. Given the small sample size, further prospective studies with a greater number of patients are warranted to confirm our results.
立体定向放射外科（SRS）是一种广泛应用于非小细胞肺癌（NSCLC）脑转移瘤（BMs）的治疗方法。然而，其在有症状的表皮生长因子受体（EGFR）突变患者中的作用仍不明确。我们回顾性分析了接受SRS作为挽救性治疗并同时接受吉非替尼治疗的有症状BMs患者的临床资料。
在对2012年1月1日至2014年8月31日期间在广东三九脑科医院接受X刀SRS治疗的患者进行回顾性分析时，确定了7例原发性NSCLC、有症状BMs且EGFR突变的患者。这些患者的中位随访时间为16个月。采用图像融合技术确定靶病变、全脑和关键脑结构的累积剂量。通过临床记录确定毒性和并发症。
由于存在脑水肿、脑室受压或其他并发症，对7例诊断为NSCLC且EGFR突变的患者（2例男性和5例女性）选择进行SRS（X刀）治疗。SRS治疗前后所有患者均无神经症状（如轻瘫、失语、感觉和视觉障碍），且所有患者术后卡氏功能状态评分（KPS）均有所改善。中位总生存期（OS）为16个月，中位无进展生存期（PFS）为10个月。
对于有症状BMs且EGFR突变的NSCLC患者，SRS（X刀）联合吉非替尼治疗可可靠地改善KPS和生存期。鉴于样本量较小，有必要进行更多患者的进一步前瞻性研究以证实我们的结果。
