Pan Kaicheng, Wang Bing, Xu Xiao, Tang Yi, Liang Jiafeng, Ma Shenglin, Xia Bing, Zhu Lucheng
Department of Radiotherapy, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, China.
Department of Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
Discov Oncol. 2025 Apr 8;16(1):488. doi: 10.1007/s12672-025-02230-x.
Patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) are at a heightened risk of developing brain metastases (BM). EGFR-tyrosine kinase inhibitors (TKI) are standard treatment for EGFR-mutated NSCLC. However, the necessity and optimal approach of brain radiotherapy for NSCLC patients with EGFR mutation remain inconclusive. We aimed to answer these questions by retrospectively analyzing the efficacy of radiotherapy in patients with BM from NSCLC with EGFR mutations.
Patients with EGFR- mutant NSCLC and BMs who were diagnosed between January 1, 2018 and December 31, 2022 were included. According to treatment methods those patients were divided into whole brain radiotherapy (WBRT) plus EGFR-TKI (WBRT group), stereotactic radiotherapy (SRT) plus EGFR-TKI (SRT group) and EGFR-TKI alone (TKI-only group). Propensity-score-matching (PSM) was performed to minimize the effect of possible confounding factors and to balance treatment groups.
A total of 142 patients were included in this study. The median follow-up time was 22 months (range, 3.0-43.0 months). In the PSM cohort, the median intracranial progression free survival (iPFS) was 14, 30, 12 months and the median overall survival (OS) was 27 months, not reach and 33 months in WBRT group, SRT group and TKI-only group, respectively. Compared with the other two groups, SRT group significantly improved iPFS and OS (p < 0.05). And the local progression rate of intracranial lesions in SRT group was significantly reduced (p < 0.05).
This study showed that SRT combined with TKI may improve iPFS and prolong survival in patients with EGFR mutations in BMs from NSCLC.
表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者发生脑转移（BM）的风险更高。EGFR酪氨酸激酶抑制剂（TKI）是EGFR突变型NSCLC的标准治疗方法。然而，对于EGFR突变的NSCLC患者，脑放疗的必要性和最佳方法仍无定论。我们旨在通过回顾性分析放疗对EGFR突变的NSCLC脑转移患者的疗效来回答这些问题。
纳入2018年1月1日至2022年12月31日期间诊断为EGFR突变型NSCLC和脑转移的患者。根据治疗方法，将这些患者分为全脑放疗（WBRT）联合EGFR-TKI组（WBRT组）、立体定向放疗（SRT）联合EGFR-TKI组（SRT组）和单纯EGFR-TKI组（单纯TKI组）。进行倾向评分匹配（PSM）以尽量减少可能的混杂因素的影响并平衡治疗组。
本研究共纳入142例患者。中位随访时间为22个月（范围3.0 - 43.0个月）。在PSM队列中，WBRT组、SRT组和单纯TKI组的中位颅内无进展生存期（iPFS）分别为14个月、30个月和12个月，中位总生存期（OS）分别为27个月、未达到和33个月。与其他两组相比，SRT组显著改善了iPFS和OS（p < 0.05）。并且SRT组颅内病变的局部进展率显著降低（p < 0.05）。
本研究表明，SRT联合TKI可能改善EGFR突变的NSCLC脑转移患者的iPFS并延长生存期。
