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Efficacy analysis of brain radiotherapy in EGFR mutation non-small cell lung cancer with brain metastasis: a
Kaicheng Pan1, Bing Wang1, Xiao Xu1
1Department of Radiotherapy, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, China.
Objectives:
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.
Methods:
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.
Results:
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).
Conclusion:
This study showed that SRT combined with TKI may improve iPFS and prolong survival in patients with EGFR mutations in BMs from NSCLC.
Insights
Stereotactic radiotherapy (SRT) combined with EGFR-tyrosine kinase inhibitors (TKI) improved intracranial progression-free survival and overall survival in non-small cell lung cancer (NSCLC) patients with brain metastases (BM). This approach also reduced local lesion progression.
Area of Science:
- Oncology
- Radiotherapy
- Medical Research
Background:
- Epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients have a high risk of brain metastases (BM).
- EGFR-tyrosine kinase inhibitors (TKI) are a standard treatment, but optimal brain radiotherapy strategies for these patients remain unclear.
Purpose of the Study:
- To retrospectively analyze the efficacy of different brain radiotherapy approaches in NSCLC patients with EGFR mutations and BM.
- To determine the optimal treatment strategy for managing brain metastases in this patient population.
Main Methods:
- Retrospective analysis of 142 patients with EGFR-mutant NSCLC and BM diagnosed between 2018-2022.
- Patients were categorized into whole brain radiotherapy (WBRT) + EGFR-TKI, stereotactic radiotherapy (SRT) + EGFR-TKI, or EGFR-TKI alone groups.
- Propensity-score-matching (PSM) was used to balance treatment groups and minimize confounding factors.
Main Results:
- In the PSM cohort, the SRT + EGFR-TKI group showed significantly improved intracranial progression-free survival (iPFS) and overall survival (OS) compared to WBRT + EGFR-TKI and EGFR-TKI alone.
- The median iPFS was 30 months in the SRT group, versus 14 months (WBRT) and 12 months (TKI-only).
- SRT significantly reduced the local progression rate of intracranial lesions.
Conclusions:
- Stereotactic radiotherapy (SRT) combined with EGFR-tyrosine kinase inhibitors (TKI) demonstrates superior efficacy in managing brain metastases for EGFR-mutant NSCLC patients.
- SRT plus TKI may be an optimal strategy to improve progression-free survival and overall survival while controlling intracranial disease.
