Ni Yang, Liu Baodong, Ye Xin, Fan Weijun, Bi Jingwang, Yang Xia, Huang Guanghui, Li Wenhong, Wang Jiao, Han Xiaoying, Wei Zhigang, Meng Min
Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, Shandong Province, China.
Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical Sciences, Beijing, China.
Cardiovasc Intervent Radiol. 2019 May;42(5):693-699. doi: 10.1007/s00270-018-02153-x. Epub 2019 Jan 30.
Most epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients treated with tyrosine kinase inhibitors (TKIs) experience oligoprogressive disease. Local ablation for isolated resistant sites continued with the original EGFR-TKI showed good efficacy in these patients. We conducted this multicenter retrospective study to investigate the potential benefit of thermal ablation in NSCLC patients that developed extra-central nervous system (CNS) oligoprogressive disease during TKI treatment.
A total of 71 EGFR-mutant patients treated with EGFR-TKIs were identified. Progression-free survival 1 (PFS1) was calculated from the initiation of TKI treatment to first progression. Patients with metastatic sites ≤ 3 in less than 3 extra-CNS organs suitable for local ablation therapy received either radiofrequency ablation or microwave ablation to these sites and continued on the original TKIs. PFS2 was defined from the first progression to second progression after ablation.
The median PFS1 for all patients was 11.8 months. Eighty extra-CNS oligoprogressive lesions in 71 patients were ablated. Thirty-six of 71 patients progressed after thermal ablation and 31 of whom died during the study period. The median PFS2 after thermal ablation was 10.0 months, and the median overall survival was 26.4 months. PFS1 and PFS2 were highly correlated with OS, whereas PFS1 was not correlated with PFS2. The numbers of oligoprogressive lesions were significantly and independently associated with PFS2.
Local thermal ablation for the oligoprogressive lesions with continuous EGFR-TKI treatment is associated with additional 10 months of disease control and should be recommended in TKI acquired resistant-NSCLC patients.
大多数接受酪氨酸激酶抑制剂（TKIs）治疗的表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）患者会出现寡进展性疾病。对孤立耐药部位进行局部消融并继续使用原EGFR-TKI治疗，在这些患者中显示出良好疗效。我们开展这项多中心回顾性研究，以探讨热消融在TKI治疗期间发生中枢神经系统（CNS）外寡进展性疾病的NSCLC患者中的潜在益处。
共纳入71例接受EGFR-TKIs治疗的EGFR突变患者。无进展生存期1（PFS1）从TKI治疗开始计算至首次进展。在少于3个适合局部消融治疗的CNS外器官中转移部位≤3个的患者，对这些部位进行射频消融或微波消融，并继续使用原TKIs。PFS2定义为消融后从首次进展至第二次进展的时间。
所有患者的中位PFS1为11.8个月。对71例患者的80个CNS外寡进展性病灶进行了消融。71例患者中有36例在热消融后进展，其中31例在研究期间死亡。热消融后的中位PFS2为10.0个月，中位总生存期为26.4个月。PFS1和PFS2与总生存期高度相关，而PFS1与PFS2不相关。寡进展性病灶的数量与PFS2显著且独立相关。
对寡进展性病灶进行局部热消融并持续EGFR-TKI治疗可使疾病控制时间延长10个月，应推荐用于TKI获得性耐药的NSCLC患者。
