Wang Chunyu, Lu Xiaotong, Zhou Zongmei, Wang Jingbo, Hui Zhouguang, Liang Jun, Feng QinFu, Chen Dongfu, Xiao Zefen, Lv Jima, Wang Xiaozhen, Wang Xin, Zhang Tao, Deng Lei, Wang Wenqing, Xiao Jianping, Li Junling, Bi Nan, Wang Luhua
Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, 100021.
Department of VIP Medical Services, National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 100021.
J Cancer. 2019 May 12;10(9):1985-1990. doi: 10.7150/jca.30131. eCollection 2019.
The high intracranial efficacy of EGFR-TKI challenges the role of upfront intracranial radiation therapy (RT) in non-small cell lung cancer (NSCLC) patients with EGFR mutation and brain metastases (BM). Therefore, we conducted a retrospective analysis to demonstrate the role of upfront RT in these patients. Patients that had histologically confirmed NSCLC with EGFR mutation, brain metastases, and received TKI or upfront RT with TKI were included in this study. Intracranial progression was estimated using the Fine-Gray competing risks model. Kaplan-Meier analysis and Log-rank test were used to evaluate and compare intracranial progression-free survival (iPFS), systemic PFS (sPFS), time to second-line systematic therapy (SST) and overall survival (OS). Among the 93 patients included, 53 patients received upfront RT and TKI, and 40 patients received TKI only. Upfront RT group showed lower intracranial progression risk with adjusted SHR 0.38 (95% CI, 0.19 to 0.75, = 0.006) and longer median time to sPFS (15.6 vs 8.9 months, = 0.009). There were 9 out of 36 (25%) and 16 out of 34 (47.1%) patients who had oligo-progression received salvage RT in the RT group and TKI group, respectively. After the salvage RT, upfront RT did not prolong the median time to SST (23.6 vs 18.9 months, =0.862) and OS (median time, 35.4 vs 35.8 months, =0.695) compared to TKI alone. Compared to upfront intracranial RT, the salvage RT to oligo-progressive disease allowed patients getting TKI to have similar time on initial TKI and OS despite worse iPFS. The best timing of intracranial RT remains to be further verified.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）的高颅内疗效对 upfront 颅内放射治疗（RT）在伴有 EGFR 突变和脑转移（BM）的非小细胞肺癌（NSCLC）患者中的作用提出了挑战。因此，我们进行了一项回顾性分析，以阐明 upfront RT 在这些患者中的作用。本研究纳入了经组织学确诊为伴有 EGFR 突变、脑转移且接受了 TKI 或 TKI 联合 upfront RT 的 NSCLC 患者。使用 Fine-Gray 竞争风险模型估计颅内进展情况。采用 Kaplan-Meier 分析和 Log-rank 检验来评估和比较颅内无进展生存期（iPFS）、全身无进展生存期（sPFS）、二线全身治疗（SST）时间和总生存期（OS）。在纳入的 93 例患者中，53 例患者接受了 upfront RT 和 TKI，40 例患者仅接受了 TKI。Upfront RT 组颅内进展风险较低，调整后的风险比（SHR）为 0.38（95%可信区间，0.19 至 0.75，P = 0.006），sPFS 的中位时间更长（15.6 个月对 8.9 个月，P = 0.009）。RT 组和 TKI 组分别有 36 例中的 9 例（25%）和 34 例中的 16 例（47.1%）寡进展患者接受了挽救性 RT。挽救性 RT 后，与单纯 TKI 相比，upfront RT 并未延长 SST 的中位时间（23.6 个月对 18.9 个月，P = 0.862）和 OS（中位时间，35.4 个月对 35.8 个月，P = 0.695）。与 upfront 颅内 RT 相比，对寡进展性疾病的挽救性 RT 使接受 TKI 的患者在初始 TKI 治疗时间和 OS 方面相似，尽管 iPFS 较差。颅内 RT 的最佳时机仍有待进一步验证。
