Wen-Chi Yang1, Furen Xiao2, Jin-Yuan Shih3, Chao-Chi Ho3, Ya-Fang Chen4, Ham-Min Tseng2, Kuan-Yu Chen3, Wei-Yu Liao3, Chong-Jen Yu3, James Chih-Hsin Yang5, Sung-Hsin Kuo1, Jason Chia-Hsien Cheng1, Pan-Chyr Yang3, Feng-Ming Hsu6. 1. Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. 2. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 4. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. 5. Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. 6. Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hsufengming@ntuh.gov.tw.
Abstract
PURPOSE: The impact of epidermal growth factor receptor (EGFR) mutations on radiotherapy for brain metastases (BM) is undetermined. We evaluated the effects of EGFR mutation status on responses and outcomes in non-small cell lung cancer (NSCLC) patients with BM, treated with upfront or salvage stereotactic radiosurgery (SRS). METHODS AND MATERIALS: From 2008 to 2015, 147 eligible NSCLC patients with 300 lesions were retrospectively analyzed. Patterns of tyrosine kinase inhibitor (TKI) therapy were recorded. Radiographic response was assessed. Brain progression-free survival (BPFS) and overall survival were calculated and outcome prognostic factors were evaluated. RESULTS: Median follow-up time was 13.5 months. Of the EGFR-genotyped patients, 79 (65%) were EGFR mutants, and 42 (35%) were wild type. Presence of EGFR mutations was associated with higher radiographic complete response rates (CRR). Median time to develop new BM after SRS was significantly longer for mutant-EGFR patients (17 versus 10.5 months, p = 0.02), predominantly for those with adjuvant TKI therapy (26.3 versus 15 months, p = 0.01). EGFR mutations independently predicted better BPFS (HR = 0.55, p = 0.048) in multivariate analysis. CONCLUSIONS: In patients with NSCLC treated with SRS for BM, the presence of EGFR mutations is associated with a higher CRR, longer time for distant brain control, and better BPFS. The combination of SRS and TKI in selective patient group can be an effective treatment choice for BM with favorable brain control and little neurotoxicity.
PURPOSE: The impact of epidermal growth factor receptor (EGFR) mutations on radiotherapy for brain metastases (BM) is undetermined. We evaluated the effects of EGFR mutation status on responses and outcomes in non-small cell lung cancer (NSCLC) patients with BM, treated with upfront or salvage stereotactic radiosurgery (SRS). METHODS AND MATERIALS: From 2008 to 2015, 147 eligible NSCLCpatients with 300 lesions were retrospectively analyzed. Patterns of tyrosine kinase inhibitor (TKI) therapy were recorded. Radiographic response was assessed. Brain progression-free survival (BPFS) and overall survival were calculated and outcome prognostic factors were evaluated. RESULTS: Median follow-up time was 13.5 months. Of the EGFR-genotyped patients, 79 (65%) were EGFR mutants, and 42 (35%) were wild type. Presence of EGFR mutations was associated with higher radiographic complete response rates (CRR). Median time to develop new BM after SRS was significantly longer for mutant-EGFRpatients (17 versus 10.5 months, p = 0.02), predominantly for those with adjuvant TKI therapy (26.3 versus 15 months, p = 0.01). EGFR mutations independently predicted better BPFS (HR = 0.55, p = 0.048) in multivariate analysis. CONCLUSIONS: In patients with NSCLC treated with SRS for BM, the presence of EGFR mutations is associated with a higher CRR, longer time for distant brain control, and better BPFS. The combination of SRS and TKI in selective patient group can be an effective treatment choice for BM with favorable brain control and little neurotoxicity.
Authors: Devarati Mitra; Yu-Hui Chen; Richard Li; Gretchen Hermann; Katelyn Atkins; David Kozono; Elizabeth H Baldini; Ayal Aizer; Ugonma Chukwueke; Raymond H Mak Journal: Clin Transl Radiat Oncol Date: 2019-06-27
Authors: In Bong Ha; Jin Ho Song; Bae Kwon Jeong; Hojin Jeong; Yun Hee Lee; Hoon Sik Choi; Ki Mun Kang Journal: Medicine (Baltimore) Date: 2019-10 Impact factor: 1.889