Brain metastases (BM) are a frequent and severe complication associated with lung adenocarcinoma patients harboring EGFR mutation, up to 60% of patients in Asia present it. It is unclear whether synchronous or sequential dose addition based on whole brain radiation therapy (WBRT) and local radiotherapy for metastatic disease is superior to WBRT alone for the treatment of advanced EGFR-mutant NSCLC with brain metastases remains controversial.
We retrospectively evaluated EGFR-mutant lung adenocarcinoma patients with BMs from a single site. Patients were divided into three groups based on upfront therapy: WBRT, local radiotherapy, synchronous or sequential dose addition based on WBRT, and subsequently stratified by Lung-molGPA.
The median OS for the WBRT (n=84), local radiotherapy (n=65), and WBRT+Boost (n=84) cohorts were 32.8, 59.1, and 41.7 months, respectively (P =0.0002). After stratification according to the Lung-molGPA standard, in the group with a score of 1-2, the median OS for the WBRT (n=56), local radiotherapy (n=19), and WBRT+Boost (n=28) cohorts was 32.5, 30.9, and 30.8 months, respectively (P=0.5097). And in the group with a score of 2.5-4, the median OS for the WBRT (n =26), local radiotherapy (n=45), and WBRT+Boost (n=55) cohorts was 32, 68.4, and 51 months, respectively (P=0.0045).
This retrospective analysis showed that craniocerebral radiotherapy should be based on the patient's Lung-molGPA score in patients with EGFR-mutant lung adenocarcinoma with BM. In patients with Lung-molGPA > 2, the OS of patients with local radiotherapy was significantly longer than that of WBRT, but there was no significant difference in the effect of three radiotherapy regimens on OS in patients with Lung-molGPA < 2. Therefore, the craniocerebral radiotherapy plan of patients should be individualized according to Lung-molGPA score.
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Legal entity responsible for the study
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences.
Has not received any funding.
The author has declared no conflicts of interest.