Management of medically inoperable and tyrosine kinase inhibitor-naïve early-stage lung adenocarcinoma with epidermal growth factor receptor mutations: a retrospective multi-institutional analysis
Yuemei Sun,
Mengwan Wu,
Mingxiu Zhou,
Xing Luo,
Yan Guo,
Hansong Bai,
Zican Zhang,
Wei Tian,
Xiaoshan Wang,
Yifeng Bai,
Xueqiang Zhu,
Haixia Pan,
Ying Deng,
Honglin Hu,
Jianling Xia,
Xinbao Hao,
Liangfu Han,
Min Wei,
Yingyi Liu,
Ming Zeng
Affiliations
Yuemei Sun
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Mengwan Wu
School of Medicine, University of Electronic Science and Technology of China
Mingxiu Zhou
School of Medicine, University of Electronic Science and Technology of China
Xing Luo
School of Medicine, University of Electronic Science and Technology of China
Yan Guo
School of Medicine, University of Electronic Science and Technology of China
Hansong Bai
School of Medicine, University of Electronic Science and Technology of China
Zican Zhang
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Wei Tian
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Xiaoshan Wang
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Yifeng Bai
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Xueqiang Zhu
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Haixia Pan
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Ying Deng
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Honglin Hu
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Jianling Xia
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Xinbao Hao
Sino-America Cancer Center, Hainan Medical University, First Affiliated Hospital of Hainan Medical College
Liangfu Han
Cancer Center, BoaoEvergrande International Hospital, Qionghai
Min Wei
Cancer Center, Ziyang People’s Hospital
Yingyi Liu
Dept of Radiation Oncology, Sichuan Friendship Hospital, Chengdu
Ming Zeng
Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Abstract Background The clinical value of combined local radiation and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) for medically inoperable and TKI-naïve early-stage lung adenocarcinoma patients with EGFR mutations has not yet been determined. In this study, we aimed to pool multi-institutional data to compare the therapeutic effect of EGFR-TKI treatment alone and combined radiation and TKI treatment on the survival outcomes in this patient subgroup. Methods A total of 132 cases of medically inoperable stage I to III EGFR mutant lung adenocarcinoma were retrospectively reviewed based on data from 5 centers. Among these patients, 65 received combined radiation and EGFR-TKI therapy (R + TKI) (49.2%), while 67 received EGFR-TKI (50.8%) treatment alone. All patients were followed until death. Results For the R + TKI group, the median overall survival (OS) after primary therapy was 42.6 months, while that of the TKI alone group was 29.4 months (log-rank p < 0.001). In terms of progression-free survival (PFS), the median PFS in these two treatment groups was 24 months and 14.7 months respectively (log-rank p < 0.001). Multivariate analysis showed that R + TKI was independently associated with improved OS (adjusted HR 0.420; 95% CI 0.287 to 0.614; p < 0.001) and PFS (adjusted HR 0.420; 95% CI 0.291 to 0.605; p < 0.001) compared to TKI alone. Subgroup analysis confirmed the significant OS benefits in stage III patients and RFS benefits in stage II/III patients. Conclusions Upfront radiation to primary sites with subsequent TKI treatment is a feasible option for patients with medically inoperable EGFR-mutant non-small-cell lung carcinoma (NSCLC) during first-line EGFR-TKI treatment, with significantly improved PFS and OS compared with those yielded by TKI treatment alone.
