Cranial Irradiation for Patients with Epidermal Growth Factor Receptor (EGFR) Mutant Lung Cancer Who Have Brain Metastases in the Era of a New Generation of EGFR Inhibitors

The oncologist

article

Jih-Hsiang Lee¹  James Chih-Hsin Yang¹  Hsuan-Yu Chen⁴  Feng-Ming Hsu¹  Jin-Shing Chen⁵  Wei-Yu Liao⁶  Jin-Yuan Shih⁶  Chong-Jen Yu⁶  Kuan-Yu Chen⁶  Tzu-Hsiu Tsai⁶ 

[1] Department of Oncology, National Taiwan University Hospital;Graduate Institute of Oncology, National Taiwan University;Center of Oncology Medicine, National Taiwan University Hospital Hsin-Chu Branch;Institute of Statistical Science;Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital;Department of Internal Medicine, National Taiwan University Hospital

关键词: Non-small cell lung cancer;    Brain metastases;    Epidermal growth factor receptor;    Cranial irradiation;    Targeted therapies;   

DOI  :  10.1634/theoncologist.2019-0152

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Immediate whole brain radiation (WBRT) has been the standard for patients with lung cancer with brain metastases. The study aims to evaluate the effect of immediate cranial irradiation in patients with epidermal growth factor receptor (EGFR) mutant lung cancer in the era of a new generation of EGFR inhibitors. Materials and Methods Medical records of 198 patients with EGFR mutant non-small cell lung cancer and brain metastases at initial metastatic diagnosis were reviewed. Patients were categorized into four groups: immediate WBRT, immediate cranial stereotactic radiosurgery (SRS), delayed radiation upon progression of cranial lesions (DRT), and never cranial irradiation (NRT). Overall survival (OS) and progression-free survival related to EGFR inhibitors were analyzed. Results The SRS group had the fewest brain metastases and fewest extracranial lesions, and the DRT and NRT groups had the smallest brain metastases. Median survival were 18.5, 55.7, 21.1, and 18.2 months for the WBRT, SRS, DRT, and NRT groups, respectively. Patients who had received EGFR T790M inhibitors survived longer (41.1 vs. 19.8 months). In multivariate analysis, the OS of patients in the SRS group was longer than that in the NRT group (adjusted hazard ratio [aHR]: 0.315). Patients who had fewer extracranial lesions and who had received EGFR T790M inhibitor treatments also survived longer (aHR: 0.442 and 0.357, respectively). Conclusion Immediate stereotactic radiosurgery but not whole brain radiation was associated with longer survival. Because of patient heterogeneity and the introduction of EGFR T790M inhibitors, the timing and modality of cranial irradiation should be determined individually, and cranial irradiation may be omitted for selected patients. Implications for Practice Immediate whole brain radiation has been the standard for patients with lung cancer with brain metastases. In this study, it was observed that, for patients with epidermal growth factor receptor (EGFR) mutant advanced lung cancer who had brain metastases, there was no difference in survival between patients who never received cranial irradiation and those who received whole brain radiation immediately. Patients who received immediate stereotactic radiosurgery or who had ever received EGFR T790M inhibitors survived longer. Patients who received immediate stereotactic radiosurgery have fewer brain metastases. These findings suggest that the timing and modality of cranial irradiation should be determined individually, and cranial irradiation may be omitted in selected patients.

【 授权许可】

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