Brain metastases (BM) are the major cause of death in patients with non-small-cell lung cancer (NSCLC). The use of upfront epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and the withholding of whole-brain radiation therapy (WBRT) is controversial. We aimed at the impact of WBRT on overall survival (OS).
A total of 141 EGFR-mutated NSCLC patients with BM were included. All patients received EGFR-TKIs with or without WBRT between 2011 and 2015 at three cancer centers. Patient follow-up was conducted by clinic visits or telephone calls until June 2018. OS was measured from the date of brain metastases. The survival data were collected and analyzed by Kaplan-Meier analysis and the Cox regression method.
All patients had TKIs. The median duration of TKIs use was 12.5 months (95% confidence interval (CI), 10.5-14.4). Ninety-four patients (66.7%) had been treated with WBRT (TKI + WBRT group) with mean radiation dose of 3781±749cGy to brain metastases. With a median follow-up of 20.3 months (95% CI, 16.9-23.7), the median survival after BM was 14.3 months (95% CI, 9.5-18.3) for patients who underwent WBRT (TKI + WBRT group) and 2.3 months (95% CI, 2-2.6) for patients who did not accept WBRT (TKI alone group). The mean survival after BM were 18± 15.2 months and 7.1± 10.8 months in TKI+WBRT group and TKI alone group, respectively (P < 0.001). On multivariate analysis, WBRT, female gender and lung surgery were associated with improved OS (P < 0.001). The 1-year survival rate were 81.9% versus 59.6% in TKI+WBRT group and TKI alone group, respectively (P = 0.002).
EGFR-mutant NSCLC patients with BM benefited from the combination of EGFR-TKIs and WBRT. Further prospective study is warranted.
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