Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Department of Oncology, Jintang First People's Hospital, Jintang, China.
Asia Pac J Clin Oncol. 2023 Dec;19(6):731-738. doi: 10.1111/ajco.13957. Epub 2023 Apr 23.
For epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) patients with limited brain metastases (BMs), who eventually receive both tyrosine kinase inhibitors (TKIs) treatment and brain radiotherapy, the optimal timing of radiotherapy is not clear. The present retrospective analysis aimed to partly solve this problem.
In total 84 EGFR-mutated NSCLC patients with limited BMs, who received both TKI treatment and brain hypofractionated stereotactic radiotherapy (HSRT), were enrolled. Patients were divided into three groups based on whether the HSRT was administrated 2 weeks before or after the beginning of TKI treatment (upfront HSRT), when intracranial lesions stabilized after TKI treatment (consolidative HSRT), or when the intracranial disease progressed after TKI treatment (salvage HSRT). The clinical efficacy and toxicities were evaluated.
The median intracranial progression-free survival (iPFS) and overall PFS calculated from the initiation of HSRT (iPFS1 and PFS1) of all patients were 17.5 and 13.1 months, respectively. The median iPFS and PFS calculated from the initiation of TKI treatment (iPFS2 and PFS2) of all patients were 24.1 and 18.4 months, respectively. Compared to consolidative and salvage HSRT, upfront HSRT improved iPFS1 (not reached vs. 17.5 months vs. 11.0 months, p < 0.001) and PFS1 (18.4 months vs. 9.1 months vs. 7.9 months, p < 0.001), and reduced the initial intracranial failure rate (12.5% vs. 48.1% vs. 56%, p < 0.001). However, there were no significant differences between the three groups for iPFS2, PFS2, and overall survival. Hepatic metastases and diagnosis-specific Graded Prognostic Assessment (ds-GPA) at 2-3 were poor prognostic factors.
For patients who receive both TKI treatment and brain HSRT, the timing of HSRT does not seem to influence the eventual therapeutic effect. Further validation in prospective clinical studies is needed.
对于表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者，若其发生有限的脑转移（BM），最终会接受酪氨酸激酶抑制剂（TKIs）治疗和脑部放射治疗，放射治疗的最佳时机尚不清楚。本回顾性分析旨在部分解决这一问题。
共纳入 84 例接受 TKI 治疗和脑部适形分割立体定向放射治疗（HSRT）的 EGFR 突变 NSCLC 伴有限 BM 患者。根据 HSRT 是在 TKI 治疗开始前（ upfront HSRT）、TKI 治疗后颅内病变稳定时（巩固性 HSRT）或 TKI 治疗后颅内疾病进展时（挽救性 HSRT）进行分组。评估临床疗效和毒性。
所有患者从 HSRT 开始的中位颅内无进展生存期（iPFS）和总无进展生存期（PFS）分别为 17.5 和 13.1 个月。所有患者从 TKI 治疗开始的中位 iPFS 和 PFS 分别为 24.1 和 18.4 个月。与巩固性和挽救性 HSRT 相比， upfront HSRT 改善了 iPFS1（未达到 vs. 17.5 个月 vs. 11.0 个月，p<0.001）和 PFS1（18.4 个月 vs. 9.1 个月 vs. 7.9 个月，p<0.001），降低了初始颅内失败率（12.5% vs. 48.1% vs. 56%，p<0.001）。然而，三组之间 iPFS2、PFS2 和总生存期无显著差异。肝转移和诊断特异性预后评分（ds-GPA）2-3 是预后不良的因素。
对于同时接受 TKI 治疗和脑部 HSRT 的患者，HSRT 的时机似乎并不影响最终的治疗效果。需要进一步在前瞻性临床研究中验证。
