Whole-Brain Radiotherapy Can Improve the Survival of Patients with Multiple Brain Metastases from Non-Small Cell Lung Cancer Treated by Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors

Abstract

Cheng Chen,1,2,* Yan Wu,2 Bao Ling Liu,2 Hong Wei Wang,2 Jian Hua Ma,2,* Ju Ying Zhou1,* 1Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 2Department of Radiotherapy, The Second People’s Hospital of Lianyungang, Lianyungang, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ju Ying ZhouDepartment of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] Hua MaDepartment of Radiotherapy, The Second People’s Hospital of Lianyungang, NO. 161 Xingfu Road, Lianyungang, Jiangsu Province 222023, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: To observe whether whole-brain radiotherapy (WBRT) can bring survival benefits to patients with multiple brain metastases (BM) from non-small cell lung cancer (NSCLC) treated by epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) and determine the best time for WBRT intervention.Methods: A retrospective analysis was performed on 148 patients diagnosed with EGFR gene-mutated NSCLC. All patients had multiple BM and received EGFR-TKI targeted therapy, which was performed to observe whether WBRT can bring survival benefits, and whether the choice of WBRT timing affects the survival of patients.Results: Among the 148 patients with NSCLC treated with EGFR-TKI, 76 received WBRT; 72 were without WBRT. WBRT can reduce the intracranial progression rate in the patients (19.7% vs 33.3%, P=0.040), thus improving the intracranial progression-free survival (iPFS) (median iPFS: 11.9 months versus 10.2 months, P=0.039) and overall survival (OS) (median OS: 21.0 months versus 16.7 months, P=0.043). Multivariate analysis showed that WBRT (HR=0.606; 95% CI: 0.403– 0.912, P=0.016) and the low Eastern Cooperative Oncology Group performance status (HR=1.884; 95% CI: 1.120– 3.170, P=0.017) are independent prognostic factors in all patients. Further subgroup analysis showed that the choice of WBRT time had no effect on patient survival.Conclusion: WBRT can improve the survival of patients with multiple BM from NSCLC receiving EGFR-TKI targeted therapy and is an independent prognostic factor. The choice of RT time has no effect on patient survival.Keywords: epidermal growth factor receptor-tyrosine kinase inhibitors, whole-brain radiotherapy, non-small cell lung cancer, multiple brain metastases

Keywords

• epidermal growth factor receptor tyrosine kinase inhibitors
• whole-brain radiotherapy
• non-small cell lung cancer
• multiple brain metastases