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Authors Li C, Guo J, Zhao L, Hu F, Nie W, Wang H, Zheng X, Shen Y, Gu P, Zhang Y, Zhang X
Received 3 December 2018
Accepted for publication 15 February 2019
Published 23 April 2019 Volume 2019:11 Pages 3433—3443
DOI https://doi.org/10.2147/CMAR.S196881
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Dr Ahmet Emre Eskazan
Purpose: This
study aimed to evaluate the efficacy of upfront whole-brain radiotherapy (WBRT)
in EGFR-mutant lung adenocarcinoma patients with multiple brain metastases
(BM).
Methods: In this
study, 195 patients with EGFR mutations who had multiple BM at preliminary
diagnosis were included and retrospectively reviewed. Patients were admitted to
receive the following treatments in a multi-disciplinary setting: upfront WBRT
followed by EGFR-TKI, concurrent EGFR-TKI and WBRT and upfront EGFR-TKI
followed by WBRT. A disease-specific graded prognostic assessment (DS-GPA) was
performed for all the patients. The treatment response and overall survival
(OS) were assessed as well.
Results: The
median OS of these patients was 27 months. Objective response rate (ORR) was
significantly better in upfront WBRT group than other two groups (P =0.004). Moreover,
patients who received upfront WBRT (n=67) had longer OS than the concomitant
group (36 vs 25 months; P =0.006) and the upfront EGFR-TKI group (36 vs 25
months; P <0.0001).
The prognosis of patients with different DS-GPA scores significantly differed (P <0.0001). In
concomitant group and upfront EGFR-TKIs group, patients with higher DS-GPA
scores of 2–3 had more favorable prognosis compared with those with lower
DS-GPA scores of 0–1.5 (27 vs 25 months; P =0.023). Patients
who received EGFR-TKIs concurrently with WBRT had longer OS than those received
upfront EGFR-TKIs with high DS-GPA scores. (37 vs 17 months; P =0.023).
Conclusion: The use
of upfront WBRT for EGFR-mutated lung adenocarcinoma patients with multiple BM
can improve ORR and OS. More importantly, patients with high DS-GPA scores are
recommended to receive WBRT immediately after EGFR-TKIs therapy.
Keywords: non-small
cell lung cancer, brain metastases, EGFR, tyrosine kinase inhibitors, whole
brain radiotherapy