Purpose Epidermal growth factor receptor (EGFR)-mutant lung cancers have a high risk of developing brain metastases (BM). Whole brain radiotherapy (WBRT), local radiotherapy, and WBRT + Boost are frequently used for treatment of BM. This retrospective study aimed to evaluate the difference in efficacy of these radiotherapy modes in patients with EGFR-mutant lung adenocarcinoma with BMs. Further, we determined the optimal radiotherapy regimen for patients based on Lung-molGPA. Methods and materials We retrospectively enrolled 232 patients with EGFR-mutant lung adenocarcinoma with BMs. Patients were divided into three groups based on the different modes of brain radiotherapy: WBRT group, local radiotherapy group, and WBRT + Boost group. Graded prognostic assessment for lung cancer using molecular markers (Lung molGPA), overall survival (OS), and intracranial progression-free survival (iPFS) were calculated. Kaplan–Meier was used to compare iPFS and OS in different groups. Results The median OS for the WBRT (n = 84), local radiotherapy (n = 65), and WBRT + Boost (n = 83) cohorts was 32.8, 59.1, and 41.7 months, respectively (P = 0.0002). After stratification according to the Lung-molGPA score, 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, in subgroup with score 1–2 (P = 0.5097). In subgroup with score 2.5–4, the median OS for the WBRT (n = 26), local radiotherapy (n = 45), and WBRT + Boost (n = 54) cohorts was 32, 68.4, and 51 months, respectively (P = 0.0041). Conclusion The present study showed that in patients with EGFR-mutant lung adenocarcinoma with BM, local radiotherapy and WBRT + Boost perform similarly well both in the subgroups with low and high scores of Lung-molGPA. Considering the side effect caused by whole brain radiotherapy, we recommended local radiotherapy as optimal brain radiation mode for those subtype lung cancer patients.

Introduction The aim of this study was to investigate the role of local radiotherapy in the management of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancers (NSCLCs) treated with EGFR tyrosine kinase inhibitors (TKIs). Materials and Methods Patients with stage IV EGFR-mutant NSCLC treated with radiotherapy concomitant to EGFR TKIs from May 2010 to December 2017 were retrospectively identified. Overall survival (OS) was the primary endpoints of the study. Results A total of 205 patients were enrolled in the study. One hundred eleven patients received one-time single-site radiotherapy (SSR), and 94 patients received multiple-site radiotherapy (MSR). Patients who received MSR had longer OS (median OS, 40.0 months; 95% confidence interval [CI], 29.6 to 50.4) than those who received SSR (median OS, 28.9 months; 95% CI, 24.3 to 33.5; P =0.031). Thoracic radiotherapy was associated with prolonged median OS (41.7 months, 95% CI, 29.0 to 54.4 vs 27.1 months, 95% CI 22.7 to 31.5; log-rank P <0.001). Multivariate analysis confirmed that thoracic radiotherapy was independently associated with improved OS (adjusted hazard ratio [HR], 0.514; 95% CI 32.3% to 81.8%; P =0.005). Conclusion MSR improves survival outcomes in patients with advanced-stage, EGFR-mutant, lung adenocarcinoma, with thoracic radiotherapy having the most significant effect on prognosis.

Aim: To verify the relationship between ARID1A and tumor immune microenvironment thus immune checkpoint inhibitors (ICIs) response. Material & methods: Several public databases were used to characterize the association between ARID1A gene alteration and tumor immunity. Results: The gene mutation frequency was 8.2% in all cancer types. The ARID1A-mutated cancers have higher scores of mutation count, tumor mutational burden, neoantigen load (p < 0.001) and T cell repertoire, B cell repertoire diversity (p < 0.05). The gene mutation has tight association with multiple-activated immune cells. Survival analysis suggested that patients with ARID1A mutant cancers benefit more from ICIs treatment (p = 0.013). Conclusion: The ARID1A gene mutation was correlated with higher tumor immunogenicity and activated antitumor immune microenvironment, resulting in superior cohort that respond well to ICIs.

Background: Perfusion-weighted magnetic resonance imaging (MRI) can evaluate collateral circulation in patients with acute cerebral infarction by reflecting hemodynamic signals in the brain. The purpose of this study was to evaluate the collateral circulation and short-term prognosis of patients with acute cerebral infarction, using perfusion-weighted MRI. Methods:The study enrolled 206 patients with acute cerebral infarction due to unilateral cerebral artery occlusion diagnosed by digital subtraction angiography (DSA) and computed tomography angiography (CTA). The relative cerebral blood volume (rCBV), relative cerebral blood flow map (rCBF), relative peak time (rTTP), and relative mean transit time (rMTT) were calculated based on the ratio of the perfusionweighted MRI reference values of the infarcted side and the control side of the patient. According to the results of perfusion-weighted MRI, patients were divided into a high perfusion group (n=121) and a low perfusion group (n=85). The Thrombolysis in Cerebral Infarction scale proposed by Higashida et al. in 2003 (Higashida scale) was used to evaluate the establishment of collateral circulation on the day of admission and 15 days after admission. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale assessed the short-term prognosis of patients with cerebral infarction. The Spearman correlation analysis examined the correlation between the rCBV, rCBF, and NIHSS scores, and the modified Rankin scale (mRS).Results: Compared with the patients in the low perfusion group, the rCBV and rCBF in the infarcted area of the patients in the high perfusion group were significantly increased and the rTTP and rMTT were significantly decreased. On day 15 after admission, the collateral circulation rate of the high perfusion group was significantly higher than that of the low perfusion group, and the NIHSS score and the mRS score were significantly lower than those scores of the low perfusion group. Perfusion-weighted MRI indexes, rCBV, and rCBF were negatively correlated with the NIHSS score and Rankin scale.Conclusions: Perfusion-weighted MRI can effectively evaluate the compensatory ability of collateral circulation and the prognosis of patients with acute cerebral infarction.

Background and PurposeEpidermal growth factor receptor (EGFR)-mutant lung cancers are associated with a high risk of developing brain metastases (BM). Craniocerebral radiotherapy is a cornerstone for the treatment of BM, and EGFR-TKIs act on craniocerebral metastases”. However, whether EGFR-TKIs combined with craniocerebral radiotherapy can further increase the efficacy and improve the prognosis of patients is unclear. This study aimed to evaluate the difference in efficacy between targeted-therapy alone and targeted-therapy combined with radiotherapy in EGFR-mutant lung adenocarcinoma patients with BM.Materials and MethodsA total of 291 patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutations were enrolled in this retrospective cohort study. Propensity score matching (PSM) was conducted using a nearest-neighbor algorithm (1:1) to adjust for demographic and clinical covariates. Patients were divided into two groups: EGFR-TKIs alone and EGFR-TKIs combined with craniocerebral radiotherapy. Intracranial progression-free survival (iPFS) and overall survival (OS) were calculated. Kaplan–Meier analysis was used to compare iPFS and OS between the two groups. Brain radiotherapy included WBRT, local radiotherapy, and WBRT+Boost.ResultsThe median age at diagnosis was 54 years (range: 28–81 years). Most patients were female (55.9%) and non-smokers (75.5%). Fifty-one pairs of patients were matched using PSM. The median iPFS for EGFR-TKIs alone (n=37) and EGFR-TKIs+craniocerebral radiotherapy (n=24) was 8.9 and 14.7 months, respectively. The median OS for EGFR-TKIs alone (n=52) and EGFR-TKIs+craniocerebral radiotherapy (n=52) was 32.1 and 45.3 months, respectively.ConclusionIn EGFR-mutant lung adenocarcinoma patients with BM, targeted therapy combined with craniocerebral radiotherapy is an optimal treatment.

e21067 Background: To evaluate the therapeutic effects of combining epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) with radiotherapy on the prognosis of patients with stage IV lung adenocarcinomas (LUAD) that harbor either exon 19 deletion (19-Del) or exon 21 L858R mutation (21-L858R). Methods: Clinical data in the real-world study were retrospectively collected and analyzed from 177 stage IV LUAD patients who received the combination of EGFR-TKIs and radiotherapy at Shandong Cancer Hospital between June 2012 and August 2017. And the primary endpoint of the study was overall survival (OS). Results: The results revealed that the stage IV LUAD patients harboring 19-Del showed similar clinical characteristics as those harboring 21-L858R (all P > 0.05). The median OS (mOS) of all patients was 32.0 (95%CI, 28.6-35.5) months. Multivariate analysis identified EFGR mutations and thoracic radiotherapy as the independent factors in predicting OS ( P = 0.001, 0.013, respectively). Moreover, subgroup analysis showed that patients who received EGFR-TKIs plus bone metastasis radiotherapy or thoracic radiotherapy showed a longer OS in 19-Del group than those in 21-L858R group (mOS, 34.7 vs. 25.1 months, 51.0 vs. 29.6 months; P = 0.0056, 0.0013, respectively), while not observed for patients with brain metastasis radiotherapy (mOS, 34.7 vs. 25.1 months; P = 0.088). Conclusions: Although there were no significant differences in clinical characteristics of stage IV LUAD patients between 19-Del group and 21-L858R group, patients harboring 19-Del could still achieve longer OS than those harboring 21-L858R after receiving EGFR-TKIs in combination with radiotherapy.

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We present an atom-based approach for determining microwave electric and magnetic fields by using a single rubidium vapor cell in a microwave waveguide. For a 87Rb cascade three-level system employed in our experiment, a weak probe laser driving the lower transition, 5S1/2→5P3/2, is first used to measure the microwave magnetic field based on the atomic Rabi resonance. When a counter-propagating strong coupling laser is subsequently turned on to drive the Rydberg transition, 5P3/2→67D5/2, the same probe laser is then used as a Rydberg electromagnetically induced transparency (EIT) probe to measure the microwave electric field by investigating the resonant microwave dressed Autler-Townes splitting (ATS). By tuning the hyperfine transition frequency of the ground state using an experimentally feasible static magnetic field, we first achieved a measurement of the microwave electric and magnetic field strength at the same microwave frequency of 6.916 GHz. Based on the ideal relationship between the electric and magnetic field components, we obtained the equivalent microwave magnetic fields by fitting the inversion to the measured microwave electric fields, which demonstrated that the results were in agreement with the experimental measurement of the microwave magnetic fields in the same microwave power range. This study provides new experimental evidence for quantum-based microwave measurements of electric and magnetic fields by a single sensor in the same system.