全脑放疗时间对EGFR突变非小细胞肺癌脑转移患者生存的影响

BACKGROUND AND OBJECTIVE: There is no high-level evidence for the time of whole brain radiotherapy (WBRT) for patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) and brain metastases.The aim of this study is to assess the appropriate timing of WBRT for patients with EGFR-mutated NSCLC and brain metastases (BM). METHODS: There were 78 patients diagnosed with EGFR-mutated NSCLC and BM in Beijing Chest Hospital between August 2009 and May 2015.48 untreated patients who received both WBRT and EGFR-tyrosine kinase inhibitors (TKIs) therapy.Prognostic factors of intracranial progression-free survival (PFS) and overall survival (OS) were identified by Cox proportional hazards modeling. RESULTS: Intracranial objective response rate was 81.3% and disease control rate was 93.8%.Median intracranial PFS was 10 months.Median OS was 18 months.Multivariate analysis of intracranial PFS revealed that Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 (HR=30.436, 95%CI:4.721-196.211, P < 0.001) and early WBRT (HR=3.663, 95%CI:1.657-8.098, P=0.001) had a better intracranial PFS.Multivariate analysis of OS revealed that PS 0-1 (HR=57.607, 95%CI:6.135-540.953, P < 0.001), early WBRT (HR=2.757, 95%CI:1.140-6.669, P=0.024), and stereotactic radiosurgery (HR=5.964, 95%CI:1.895-18.767, P=0.002) were independent prognostic factors of OS. CONCLUSION: Early WBRT combined with EGFR-TKIs can improve outcomes of patients with EGFR-mutated NSCLC and BM, but it needs to be confirmed by large-sample-size and multicenter prospective clinical trials.