Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Republic of Korea.
PLoS One. 2020 Apr 16;15(4):e0231546. doi: 10.1371/journal.pone.0231546. eCollection 2020.
In patients with epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) with brain metastases, it remains controversial whether the use of EGFR-tyrosine kinase inhibitor (TKI) alone without radiotherapy (RT) is an optimal approach. Here, we investigated the clinical outcomes according to the use of upfront RT as well as the subsequent therapy following intracranial progression. This single-centre retrospective study included a total of 173 patients who were treated with EGFR-TKI alone (TKI alone group) or with upfront whole-brain RT (WBRT) or stereotactic radiosurgery (SRS) followed by EGFR-TKI (RT plus TKI group). Clinical outcomes according to initial and subsequent therapies following intracranial progression were analysed. There was no significant difference in OS according to the use of upfront RT (TKI alone group, 24.5 months vs. WBRT group, 20.0 months vs. SRS group, 17.8 months; P = 0.186). Intracranial progression was found in 35 (32.7%) of 107 patients in the TKI alone group. Among them, 19 patients who received salvage RT had the better prognosis than others [median overall survival (OS); 28.6 vs. 11.2 months; P = 0.041]. In the RT plus TKI group, 12 (18.1%) of the 66 patients experienced intracranial progression and 3 of them received salvage RT (median OS; 37.4 vs. 20.0 months; P = 0.044). In multivariate analysis, upfront WBRT was associated with trends towards a lower probability of intracranial progression, whereas upfront SRS was found to be an independent risk factor for poor OS. In conclusion, using EGFR-TKI alone for brain metastasis in EGFR-mutant lung cancer patients showed outcomes comparable to those using upfront RT followed by EGFR-TKI. Patients who could not receive salvage RT following intracranial progression had the worst survival regardless of the type of initial treatment.
在表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）伴脑转移患者中，EGFR 酪氨酸激酶抑制剂（TKI）单独使用而不进行放射治疗（RT）是否为最佳方法仍存在争议。在这里，我们根据颅内进展前 RT 的使用以及颅内进展后后续治疗的情况，研究了临床结局。这项单中心回顾性研究共纳入了 173 名单独接受 EGFR-TKI 治疗（TKI 单独组）或接受初始全脑 RT（WBRT）或立体定向放射外科手术（SRS）后再接受 EGFR-TKI 治疗（RT 加 TKI 组）的患者。分析了根据颅内进展后的初始和后续治疗的临床结局。根据颅内进展前 RT 的使用，OS 无显著差异（TKI 单独组为 24.5 个月，WBRT 组为 20.0 个月，SRS 组为 17.8 个月；P=0.186）。在 TKI 单独组的 107 名患者中，有 35 名（32.7%）患者出现颅内进展。其中，19 名接受挽救性 RT 的患者预后较好[中位总生存期（OS）；28.6 与 11.2 个月；P=0.041]。在 RT 加 TKI 组中，66 名患者中有 12 名（18.1%）出现颅内进展，其中 3 名接受挽救性 RT[中位 OS；37.4 与 20.0 个月；P=0.044]。多因素分析显示，初始 WBRT 与颅内进展概率降低趋势相关，而初始 SRS 是 OS 较差的独立危险因素。总之，对于 EGFR 突变型肺癌脑转移患者，单独使用 EGFR-TKI 的疗效与初始 RT 后联合 EGFR-TKI 相当。颅内进展后无法接受挽救性 RT 的患者无论初始治疗类型如何，生存最差。
