Effect of brain radiotherapy strategies on prognosis of patients with EGFR-mutant lung adenocarcinoma with brain metastasis

Abstract

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.

Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

“…A variety of clinical and pathological factors can affect the prognosis of EGFR-mutant lung adenocarcinoma with brain metastases. Therefore, we speculate that the heterogeneity of these factors between the two groups contributed to the lack of statistical difference in survival analysis (8,12,(25)(26)(27). We initially used a Chi-squared analysis to analyze whether there were differences in the general clinical characteristics between the two groups.…”

“…Lung-molGPA reportedly provides a better predictive value, suggesting that lung-molGPA can comprehensively and accurately reflect the prognosis of NSCLC complicated by brain metastases (24, 28-30). These also suggest the importance of individualized therapy for craniocerebral radiotherapy (12,(31)(32)(33). Moreover, most previous retrospective studies have shown that EGFR-TKI concurrently administered with radiotherapy was more effective than treatment with EGFR-TKI alone, which was not consistent with the results of our study (10,19,34,35).…”

“…Some studies have shown that the incidence of brain metastases in lung adenocarcinoma patients with EGFR mutations is slightly higher than that in patients with wild-type EGFR, with an approximate incidence rate of 60% (7)(8)(9), indicating that lung adenocarcinoma patients with EGFR mutations may be more prone to developing brain metastases. With advancements in systemic treatment and radiotherapy techniques, the overall survival (OS) of patients has been further prolonged from 3-6 months to 19-58 months, increasing the risk of developing brain metastases during the entire disease course (10)(11)(12)(13). The two aforementioned reasons cause a high incidence of brain metastases in EGFR-mutant patients with lung adenocarcinoma.…”

Dynamic changes in the systemic immune-inflammation index predict the prognosis of EGFR-mutant lung adenocarcinoma patients receiving brain metastasis radiotherapy

“…A score of 0–4 indicated significant impact on OS in patients. The grouping standard referred to our team's previous study, which revealed that a statistical difference in median survival between the two groups of BM patients from EGFR-mutant lung adenocarcinoma with a score of 1–2 and a score of 2.5–4 [ 15 ].…”

Correction to: Effect of brain radiotherapy strategies on prognosis of patients with EGFR-mutant lung adenocarcinoma with brain metastasis

“…In the original publication [ 1 ] there was an incorrect funding section. The incorrect and correct funding information is published in this correction article.…”