Chen Chien-Hung, Lee Hsin-Hua, Chuang Hung-Yi, Hung Jen-Yu, Huang Ming-Yii, Chong Inn-Wen
Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan.
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Cancers (Basel). 2019 Jul 31;11(8):1092. doi: 10.3390/cancers11081092.
Brain metastases (BM) cause morbidity and mortality in patients with non-small cell lung cancer (NSCLC). The use of upfront epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and withholding of whole-brain radiation therapy (WBRT) is controversial. We aim to investigate the impact of WBRT on overall survival (OS). After screening 1384 patients, a total of 141 EGFR-mutated patients with NSCLC and BM were enrolled. All patients received EGFR-TKIs between 2011 and 2015. Ninety-four patients (66.7 %) were treated with WBRT (TKI + WBRT group). With a median follow-up of 20.3 months (95% confidence interval (CI), 16.9-23.7), the median OS after the diagnosis of BM was 14.3 months (95% CI, 9.5 to 18.3) in the TKI + WBRT group and 2.3 months (95% CI, 2 to 2.6) in the TKI alone group. On multivariate analysis, WBRT ( < 0.001), female, surgery to primary lung tumor, and surgery to BM were associated with improved OS. The 1-year OS rate was longer in the TKI+WBRT group than that in the TKI alone group (81.9% vs 59.6%, = 0.002). In conclusion, this is the first study to demonstrate the negative survival impact from the omission of WBRT in patients with EGFR-mutant NSCLC.
脑转移（BM）可导致非小细胞肺癌（NSCLC）患者发病和死亡。 upfront使用表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）并停用全脑放射治疗（WBRT）存在争议。我们旨在研究WBRT对总生存期（OS）的影响。在筛选了1384例患者后，共纳入了141例EGFR突变的NSCLC和BM患者。所有患者在2011年至2015年期间接受了EGFR-TKIs治疗。94例患者（66.7%）接受了WBRT（TKI+WBRT组）。中位随访20.3个月（95%置信区间（CI），16.9 - 23.7），TKI+WBRT组BM诊断后的中位OS为14.3个月（95%CI，9.5至18.3），单纯TKI组为2.3个月（95%CI，2至2.6）。多因素分析显示，WBRT（<0.001）、女性、原发性肺肿瘤手术和BM手术与OS改善相关。TKI+WBRT组的1年OS率长于单纯TKI组（81.9%对59.6%，=0.002）。总之，这是第一项证明EGFR突变NSCLC患者省略WBRT对生存有负面影响的研究。
