Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Int J Radiat Oncol Biol Phys. 2019 Jul 1;104(3):604-613. doi: 10.1016/j.ijrobp.2019.02.051. Epub 2019 Mar 6.
It is unclear whether local therapy (LT) or epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) should take precedence for patients with EGFR-mutant non-small cell lung cancer (NSCLC) and brain metastases (BMs). The number of BMs is important in the choice of LT, including whole-brain radiation therapy, stereotactic radiosurgery, and surgery.
We retrospectively evaluated cases of EGFR-mutant non-small cell lung cancer with BMs from a single site. Patients were divided into 2 groups based on upfront therapy-EGFR-TKI (TKI) or LTs-and subsequently stratified by the number of BMs.
Among 176 patients, 61% received upfront EGFR-TKI, and 39% received upfront LT. The number of patients with 1 to 4 BMs was similar (56% vs 52%; P = .61). All patients with 1 to 4 BMs in the LT group, except for surgical cases, received stereotactic radiosurgery (n = 31). Among those with ≥5 BMs, most (n = 27; 82%) received whole-brain radiation therapy. There was no significant difference in OS between LT and TKI groups (median overall survival, 28 vs 23 months; hazard ratio, 0.75; 95% confidence interval, 0.52-1.07). In patients with 1 to 4 BMs, the LT group showed significantly better OS compared with the TKI group (median overall survival, 35 vs 23 months; hazard ratio, 0.54; 95% confidence interval, 0.32-0.90). There was no difference in OS between the LT and TKI groups for patients with ≥5 BMs. Multivariable analysis showed that upfront LT yielded significantly better OS for patients with 1 to 4 BMs.
Upfront LT followed by EGFR-TKI is more effective than upfront EGFR-TKI for the survival of untreated patients harboring EGFR mutations with 1 to 4 BMs.
对于携带表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）合并脑转移（BMs）的患者，局部治疗（LT）或 EGFR 酪氨酸激酶抑制剂（TKI）应优先选择，目前尚不清楚。BMs 的数量对于 LT 的选择很重要，包括全脑放疗、立体定向放射外科和手术。
我们回顾性评估了单中心 EGFR 突变型非小细胞肺癌合并 BMs 的病例。根据一线治疗方法（TKI 或 LT）将患者分为 2 组，然后根据 BMs 的数量进一步分层。
在 176 例患者中，61%接受了 EGFR-TKI 的一线治疗，39%接受了 LT 的一线治疗。1 至 4 个 BMs 的患者数量相似（56%比 52%；P=0.61）。LT 组除手术病例外，所有 1 至 4 个 BMs 的患者均接受了立体定向放射外科治疗（n=31）。≥5 个 BMs 的患者中，大多数（n=27；82%）接受了全脑放疗。LT 组和 TKI 组的 OS 无显著差异（中位总生存期，28 比 23 个月；风险比，0.75；95%置信区间，0.52-1.07）。在 1 至 4 个 BMs 的患者中，LT 组的 OS 明显优于 TKI 组（中位总生存期，35 比 23 个月；风险比，0.54；95%置信区间，0.32-0.90）。对于≥5 个 BMs 的患者，LT 组和 TKI 组的 OS 无差异。多变量分析显示，对于 1 至 4 个 BMs 的患者，LT 是影响 OS 的独立预后因素。
对于未经治疗的携带 EGFR 突变、1 至 4 个 BMs 的患者，LT 序贯 EGFR-TKI 治疗的生存获益优于 EGFR-TKI 一线治疗。
