Hung-Ruei Liao1, Chi-Lu Chiang2,3,4, Chia-I Shen2,3,4, Ching-Jen Chen5, Huai-Che Yang1,2, Hsiu-Mei Wu6,2, Yung-Hung Luo2,3,4, Yong-Sin Hu6,2, Chung-Jung Lin6,2, Wen-Yuh Chung1,2,7, Cheng-Ying Shiau2,8, Wan-Yuo Guo6,2, David Hung-Chi Pan1,9, Cheng-Chia Lee10,11,12. 1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. 2. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 4. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. 5. Department of Neurosurgery, the University of Texas Health Science Center, Houston, TX, USA. 6. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. 7. Gamma Knife Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. 8. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan. 10. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. yfnaughty@gmail.com. 11. School of Medicine, National Yang-Ming University, Taipei, Taiwan. yfnaughty@gmail.com. 12. Brain Research Center, National Yang-Ming University, Taipei, Taiwan. yfnaughty@gmail.com.
Abstract
OBJECTIVE: Tyrosine kinase inhibitors (TKIs) is the first-line treatment for EGFR-positive non-small cell lung cancer (NSCLC); however, its applicability to patients with wild-type NSCLC remains an issue of contention. This study compared the effects of gamma knife radiosurgery (GKRS) alone versus combining GKRS and TKIs in treating two genetic forms of NSCLC. METHODS: This retrospective study examined 479 NSCLC patients with 1982 brain metastases who underwent GKRS and for whom imaging follow-up data or death records were available. All our patients were consecutive. All gene mutations were confirmed by lung biopsy. The three main endpoints in this study were overall survival (OS), local intracranial tumor control (LC), and distal intracranial tumor control (DC). RESULTS: There were 296 NSCLC patients with EGFR positive: TKI treatment (n = 262) and without TKI treatment (n = 34). GKRS + TKIs was more effective than GKRS alone in terms of OS (HR 0.53, p = 0.085) and DC (HR 0.51, p < 0.001). There were 150 NSCLC patients with wild-type EGFR: TKI treatment (n = 50) and without TKI treatment (n = 100). GKRS + TKIs was less effective than GKRS alone in terms of OS (HR 1.82, p = 0.049) and DC (HR: 1.40, p = 0.011). We observed no difference in terms of LC in both genetic groups. CONCLUSIONS: Combining GKRS with TKIs proved effective in EGFR positive NSCLC patients; however, we do not observe the similar results when combining GKRS with TKIs for patients with wild-type NSCLC.
OBJECTIVE: Tyrosine kinase inhibitors (TKIs) is the first-line treatment for EGFR-positive non-small cell lung cancer (NSCLC); however, its applicability to patients with wild-type NSCLC remains an issue of contention. This study compared the effects of gamma knife radiosurgery (GKRS) alone versus combining GKRS and TKIs in treating two genetic forms of NSCLC. METHODS: This retrospective study examined 479 NSCLC patients with 1982 brain metastases who underwent GKRS and for whom imaging follow-up data or death records were available. All our patients were consecutive. All gene mutations were confirmed by lung biopsy. The three main endpoints in this study were overall survival (OS), local intracranial tumor control (LC), and distal intracranial tumor control (DC). RESULTS: There were 296 NSCLC patients with EGFR positive: TKI treatment (n = 262) and without TKI treatment (n = 34). GKRS + TKIs was more effective than GKRS alone in terms of OS (HR 0.53, p = 0.085) and DC (HR 0.51, p < 0.001). There were 150 NSCLC patients with wild-type EGFR: TKI treatment (n = 50) and without TKI treatment (n = 100). GKRS + TKIs was less effective than GKRS alone in terms of OS (HR 1.82, p = 0.049) and DC (HR: 1.40, p = 0.011). We observed no difference in terms of LC in both genetic groups. CONCLUSIONS: Combining GKRS with TKIs proved effective in EGFR positive NSCLC patients; however, we do not observe the similar results when combining GKRS with TKIs for patients with wild-type NSCLC.
Authors: William J Magnuson; Nataniel H Lester-Coll; Abraham J Wu; T Jonathan Yang; Natalie A Lockney; Naamit K Gerber; Kathryn Beal; Arya Amini; Tejas Patil; Brian D Kavanagh; D Ross Camidge; Steven E Braunstein; Lauren C Boreta; Suresh K Balasubramanian; Manmeet S Ahluwalia; Niteshkumar G Rana; Albert Attia; Scott N Gettinger; Joseph N Contessa; James B Yu; Veronica L Chiang Journal: J Clin Oncol Date: 2017-01-23 Impact factor: 44.544
Authors: William J Magnuson; Jacky T Yeung; Paul D Guillod; Scott N Gettinger; James B Yu; Veronica L Chiang Journal: Int J Radiat Oncol Biol Phys Date: 2016-02-02 Impact factor: 7.038