Study Of Survival Factors After Radiology And Clinical Ignificance Of Combined Targeting Therapy For NSCLC Patients With Brain Metastases

BackgroundThe incidence of brain metastasis suffering Non-small cell lung cancer (NSCLC) risessharply year by year. However, there are no effective means to control the disease, whichleads to poor prognosis. At present, the role of radiotherapy for NSCLC patients with brainmetastasis is generally accepted. Gefitinib, a second-line drug used for NSCLC patients,was reported to be effective for NSCLC patients with brain metastasis. So, whetherGefitinib combined radiotherapy (general whole brain or stereotactic radiotherapy) issuperior to radiotherapy for NSCLC patients with brain metastases? Meanwhile, how toevaluate prognosis of NSCLC patients with brain metastases effectively? The answers tothese questions will be helpful to explore integrated multidisciplinary treatment modalitiesfor NSCLC patients with brain metastases.ObjectiveSystematicly analyze the risk factors that influence the progonosis and survival ofNSCLC patients with brain metastases after brain radiotheray. To evaluate the efficaciesand adverse reaction of Gefitinib combined radiotherapy in the treatment of NSCLCpatients with brain metastases, to provide clinical evidence for exporing integratedmultidisciplinary treatment modalities for NSCLC patients with brain metastases.Method1. To collect103NSCLC patients with brain metastases treated in Xingqiao Hospitalfrom January2004to november2010. Kaplan-Meier was employed for survival analysis.The differences of survival rate in all groups were analyzed with Log-rank test. Toanalyze multifactor survival relatived risk factors, Cox model was used. P<0.05meanssignificant difference. 2. A retrospective analysis was conducted for161NSCLC patients with brainmetastases in Xingqiao Hospital from January2001to January2010. Of the161patients,38patients aged from38to77years old were recevied in the combined regimen ofGefitinib combined radiotherapy. The radiotherapy included synchronically practicinggeneral or stereotactic brain radiotherapy. At the same time, patients oral intook of Gefitinib(250mg, QD, at least8consecutive weeks); The efficacy and toxicity were evaluated12weeks after the initial treatment. A total of123patients aged37to76years old undrtgoingwhole brain or stereotactic radiotherapy were used as control. x2test between the twogroups was carried out to evaluate objective response rate (ORR), disease control rate(DCR), brain metastasis related symptoms and III-IV degree of toxicity. Non-parametricrank tests was performed to compare the U.S. Eastern Cooperative Oncology Group(ECOG)performance status score between two groups.Result1. In103NSCLC patients with brain metastases, the overall survival duration was1-68months after brain radiotherapy; Median survival was10months(95％CI：7.231-12.769months);1year and2year survival rate was46.0%,22.0%respectively. Coxmultiplicity showed: ECOG scores and GPA index was independent prognosis factor thatinfluence survival rate（P=0.027，P=0.000）. According to GPA index building model ofprognosis, the survival rate between4groups was significant diffrenc（eP=0.027，P=0.000）.2. In combination therapy group, the levels of ORR and DCR were significantly higherthan those in the conventional treatment group (31.6%,78.9%vs15.4%,60.2%), thedifferences were statistically significant (x2=4.859, P=0.027and x2=4.479, P=0.034); thesignificant difference existed in brain metastasis-related symptoms between two groups(x2=4.612, P=0.037); The ECOG scores were evaluated in combined treatment group asfollows:0-1(n=18),2(n=11),3-4(n=9) at pre-treatment vs0-1(n=27),2(n=6),3-4(n=5) atpost-treatment. The ECOG score was significantly improved after treatment (Z=－2.012,P=0.044); regarding the Ⅲ-Ⅳ degree of toxicity, the combination therapy group had4patients with acne-like rash and it was significantly higher than that in the conventionaltherapy group (n=0)(P=0.003).But no difference existed in the occurrence of fatigue,nausea, vomiting, diarrhea and myelosuppression. Conclusion1. ECOG scores and GPA index was independent prognosis factors that influencesurvival rate; the GPA index can reflect the prognosis of NSCLC patients with brainmetastasis after radiotherapy.2. The combined regimen of Gefitinib plus radiotherapy can improve the therapeuticefficacies of brain metastases and enhance the quality-of-life in NSCLC patients. Sideeffects were tolerated.