Clinical Research On Whole Brain Radiotherapy With EGFR-TKIs And Chemotherapy In The Treatment Of Non-small Cell Lung Cancer With Brain Metastasis

BACKGROUND and OBJECTIVE: Brain transfer in advanced non-small cell lung cancer is quite common,about 10% of newly diagnosed patients with advanced lung cancer will be brain metastases,nearly 30%-50% of advanced lung cancer will eventually brain metastases,the prognosis is poor.The median survival time of patients with untreated brain metastases is only one month.Simple whole brain radiotherapy can only prolong the median survival of most patients by 3 to 6 months.In recent years,the application of molecular targeted drugs is extensive and the study of EGFR-TKIs in systemic therapy is more,but the study of central nervous system metastasis is limited.Therefore,more and more studies using EGFR-TKIs or EGFR-TKIs combined with whole brain radiotherapy to treat non-small cell lung cancer brain metastases.On the other hand,for advanced non-small cell lung cancer patients with brain metastases,systemic chemotherapy combined with whole brain radiotherapy is also widely used in clinical,but whether to bring more benefits to patients need a lot of clinical research.The aim of this study was to provide a best treatment option for patients with non-small cell lung cancer with brain metastases.To explore the short-term therapeutic effects,adverse effects and survival between whole brain radiotherapy with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)and chemotherapy in the treatment of non-small cell lung cancer with brain metastases.METHODS: The clinical data of 93 patients with non-small cell lung cancer with brain metastasis were analyzed retrospectively.According to the different treatment group,46 cases of brain metastases of non-small cell lung cancer patients treated with whole brain radiotherapy with EGFR-TKIs(treatment group),1 months after the start of the evaluation of curative effect,effective treatment to continue to maintain the progress of disease or have not toxicity tolerance;47 in the same period cases were treated with whole brain radiotherapy in patients with brain metastases of non-small cell lung cancer treated with platinum based chemotherapy(control group),each 21 d for 1 cycles,efficacy evaluation began after 2 cycles of chemotherapy were effective to complete the cycle to 4.Two groups of patients were treated with computed tomography(CT)or magnetic resonance imaging(MRI)examination as imaging evaluation,all patients were given according to the condition of dehydration or hormone treatment.The curative effect was evaluated by Evaluation(Response Criteria in Solid Tumors,RECIST 1 edition),and the adverse reactions were in accordance with the standard of WHO anticancer drug toxicity.Follow up was made from patients diagnosed with non-small cell lung cancer with brain metastasis,using outpatient or inpatient regular review and telephone follow-up.The comparison of the two groups of curative effect was tested by the X2 test,and the survival analysis adopted the Kaplan-Meier method,and the Log-rank method was applied to test the survival difference.RESULTS:1?Intracranial treatment group objective response rate(ORR)was 76.1% higher than that of the control group 31.9%,the difference was statistically significant(P<0.001),treatment group,disease control rate(DCR)was 93.5% 80.9% higher than the control group had no significant difference(P=0.069).2?The overall objective response rate(ORR)and disease control rate(DCR)in the treatment group were 76.1% and 93.5%,respectively,higher than those in the control group(n=31.9%)and the difference was statistically significant(P<0.001 and P=0.007).3 ? The median progression free survival(mPFS)in the treatment group and the control group was 12 months and 9 months,respectively,and the difference was statistically significant(P=0.013).The median progression free survival(mPFS)was 11 months and 8 months,and the difference was statistically significant(P=0.013).4?The 1 year survival rates of the patients in the two groups were 73.9% and 74.4%,respectively.The median overall survival(mOS)was between the ages of 28 and 23 months,respectively.The difference was not statistically significant(P=0.638).5?Subgroup analysis of 20 patients with known EGRF status of patients,the treatment group of 14 cases of EGFR gene mutation in patients,the control group of 6 cases of EGFR gene mutation in patients,objective remission rate of treatment group(ORR)was 78.6% higher than that of the control group 16.7%,the difference was statistically significant(P=0.010),the treatment group for disease control rate(DCR)was 100% higher than that of the control group 50%,the difference was statistically significant(P=0.004).The median progression free survival(mPFS)in the treatment group and the control group was 12 months and 7 months,respectively,and the difference was statistically significant(P=0.010).The median progression free survival(mPFS)was 11 months and 6.5 months,and the difference was statistically significant(P=0.043).CONCLUSION: 1?Brain metastasis of non-small cell lung cancer patients,progression free survival with whole brain radiotherapy combined with EGFR-TKIs treatment can improve the patients,obtain better objective response rate and disease control rate,and the toxicity is well tolerated,high safety,and has popularization and application value.However,there was no significant difference in the survival time between the two groups.2?For patients with EGFR mutation in non-small cell lung cancer patients with brain metastases,EGFR-TKI should be the first choice for chemotherapy.