无症状脑转移表皮生长因子受体突变非小细胞肺癌患者脑部放疗的最佳时机

The appropriate timing of brain radiotherapy for asymptomatic brain metastasis in patients with epidermal growth factor receptor mutant non-small cell lung cancer

目的探讨表皮生长因子受体(EGFR)突变阳性、无症状脑转移的非小细胞肺癌(NSCLC)患者脑部放疗(BRT)的最佳时机。方法选取50例初诊无症状脑转移的EGFR突变阳性的肺腺癌患者,分析其治疗方案、疗效以及失败模式。结果 50例患者的中位随访时间为26个月,2年总生存率为44.0%,预期生存时间为21个月。单因素分析显示ECOG评分、颅外转移灶、一线全身治疗方案与总生存期显著相关。多因素分析显示仅颅外转移灶与总生存期相关。所有患者2年脑转移无进展生存率为29.3%,预期时间为19个月。BRT时机与脑转移无进展生存时间无明显相关性。结论对于无症状脑转移的EGFR突变阳性的NSCLC患者,一线BRT无明显生存获益,一线应用酪氨酸激酶抑制剂基础上延迟BRT可能是较好的治疗选择。

Objective To assess the efficacy and appropriate timing of brain radiotherapy administration for asymptomatic brain metastasis（ BM） in patients with epidermal growth factor receptor（ EGFR） mutant non- small cell lung cancer（ NSCLC）. Methods Fifty patients diagnosed as EGFR mutant NSCLC with untreated asymptomatic BM were selected to analyze the treatment outcomes and failure patterns. Results With a median follow- up of 26 months,the 2- year overall survival（ OS） rate was 44. 0% and the estimated OS time was 21 months. On univariate analysis,ECOG performance status,other distant metastases and first line systemic treatment were independently associated with OS. The successional multivariate analysis identified only other sites of distant metastases as the prognostic factor. The 2-year brain metastases progression free survival（ BM PFS） rate was 29. 3% and the estimated time was 19 months. Whether or not receiving the first- line brain radiotherapy（ RT） didn＇t show significant association with BM PFS. Conclusions First- line brain RT doesn＇t improve OS of this cohort of patients,nor improve BM PFS. The status of systemic disease is the strongest prognostic factor. In treatment- naive NSCLC patients with an EGFR mutation and asymptomatic BM,particularly in those with active systemic disease,first- line tyrosine kinase inhibitor and delayed brain RT may be proper.