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Combination of Whole-Brain Radiotherapy with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Improves Overall Survival in EGFR-Mutated Non-Small Cell Lung Cancer Patients with Brain Metastases.

作者信息

Chen Chien-Hung, Lee Hsin-Hua, Chuang Hung-Yi, Hung Jen-Yu, Huang Ming-Yii, Chong Inn-Wen

机构信息

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.

出版信息

Cancers (Basel). 2019 Jul 31;11(8):1092. doi: 10.3390/cancers11081092.


DOI:10.3390/cancers11081092
PMID:31370314
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6721307/
Abstract

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.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3227/6721307/a22058fc7e28/cancers-11-01092-g001a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3227/6721307/a22058fc7e28/cancers-11-01092-g001a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3227/6721307/a22058fc7e28/cancers-11-01092-g001a.jpg

相似文献

[1]
Combination of Whole-Brain Radiotherapy with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Improves Overall Survival in EGFR-Mutated Non-Small Cell Lung Cancer Patients with Brain Metastases.

Cancers (Basel). 2019-7-31

[2]
Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced -mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study.

Cancer Manag Res. 2019-3-14

[3]
Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naïve Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis.

J Clin Oncol. 2017-1-23

[4]
Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases.

Int J Radiat Oncol Biol Phys. 2016-6-1

[5]
Combination of EGFR-Directed Tyrosine Kinase Inhibitors (EGFR-TKI) with Radiotherapy in Brain Metastases from Non-Small Cell Lung Cancer: A 2010-2019 Retrospective Cohort Study.

Cancers (Basel). 2023-6-1

[6]
Whole-Brain Radiotherapy Can Improve the Survival of Patients with Multiple Brain Metastases from Non-Small Cell Lung Cancer Treated by Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors.

Cancer Manag Res. 2020-11-6

[7]
Upfront whole brain radiotherapy for multiple brain metastases in patients with EGFR-mutant lung adenocarcinoma.

Cancer Manag Res. 2019-4-23

[8]
First-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor alone or with whole-brain radiotherapy for brain metastases in patients with EGFR-mutated lung adenocarcinoma.

Cancer Sci. 2016-12

[9]
Efficacy of brain radiotherapy plus EGFR-TKI for EGFR-mutated non-small cell lung cancer patients who develop brain metastasis.

Arch Med Sci. 2018-10

[10]
EGFR TKIs plus WBRT Demonstrated No Survival Benefit Other Than That of TKIs Alone in Patients with NSCLC and EGFR Mutation and Brain Metastases.

J Thorac Oncol. 2016-5-26

引用本文的文献

[1]
In-depth exploration of the focus issues of TKI combined with radiotherapy for EGFR-mutant lung adenocarcinoma patients with brain metastasis: a systematic analysis based on literature metrology, meta-analysis, and real-world observational data.

BMC Cancer. 2024-10-23

[2]
Clinical Management of Patients with Non-Small Cell Lung Cancer, Brain Metastases, and Actionable Genomic Alterations: A Systematic Literature Review.

Adv Ther. 2024-5

[3]
Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of -mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis.

Front Oncol. 2023-2-9

[4]
Safety and efficacy of combining afatinib and whole-brain radiation therapy in treating brain metastases from EGFR-mutated NSCLC: a case report and literature review.

BJR Case Rep. 2022-9-12

[5]
Upfront brain radiotherapy improves intracranial progression-free survival but not overall survival in lung adenocarcinoma patients with brain metastases: a retrospective, single-institutional analysis from China.

J Cancer. 2022-1-1

[6]
The role of systemic inflammatory cells in meningiomas.

Neurosurg Rev. 2022-4

[7]
EGFR-mutated stage IV non-small cell lung cancer: What is the role of radiotherapy combined with TKI?

Cancer Med. 2021-9

[8]
Intermuscular fat density as a novel prognostic factor in breast cancer patients treated with adjuvant chemotherapy.

Breast Cancer Res Treat. 2021-10

[9]
Whole-Brain Radiotherapy Can Improve the Survival of Patients with Multiple Brain Metastases from Non-Small Cell Lung Cancer Treated by Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors.

Cancer Manag Res. 2020-11-6

[10]
The mechanism of mA methyltransferase METTL3-mediated autophagy in reversing gefitinib resistance in NSCLC cells by β-elemene.

Cell Death Dis. 2020-11-11

本文引用的文献

[1]
A review of whole brain radiotherapy outcomes in a high epidermal growth factor receptor mutation rate population: Does QUARTZ apply in Asia?

Asia Pac J Clin Oncol. 2019-12

[2]
Cranial Irradiation for Patients with Epidermal Growth Factor Receptor (EGFR) Mutant Lung Cancer Who Have Brain Metastases in the Era of a New Generation of EGFR Inhibitors.

Oncologist. 2019-5-24

[3]
Upfront whole brain radiotherapy for multiple brain metastases in patients with EGFR-mutant lung adenocarcinoma.

Cancer Manag Res. 2019-4-23

[4]
Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced -mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study.

Cancer Manag Res. 2019-3-14

[5]
Therapeutic Effect of First-line Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKI) Combined with Whole Brain Radiotherapy on Patients with EGFR Mutation-positive Lung Adenocarcinoma and Brain Metastases.

Curr Med Sci. 2018-12-7

[6]
Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.

CA Cancer J Clin. 2018-9-12

[7]
Consolidative Local Ablative Therapy Improves the Survival of Patients With Synchronous Oligometastatic NSCLC Harboring EGFR Activating Mutation Treated With First-Line EGFR-TKIs.

J Thorac Oncol. 2018-5-29

[8]
Intracranial control and survival outcome of tyrosine kinase inhibitor (TKI) alone versus TKI plus radiotherapy for brain metastasis of epidermal growth factor receptor-mutant non-small cell lung cancer.

J Neurooncol. 2018-4-11

[9]
The biology and management of non-small cell lung cancer.

Nature. 2018-1-24

[10]
Whole brain radiotherapy after stereotactic radiosurgery or surgical resection among patients with one to three brain metastases and favorable prognoses: a secondary analysis of EORTC 22952-26001.

Ann Oncol. 2017-10-1

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