Comparision Of The Efficacy And Safety Between EGFR-TKI Single Drug Therapy And EGFR-TKI Combined With Radiotherapy For Non-small Cell Lung Cancer With Brain Metastasis:a Meta-analysis

OBJECTIVE: To compare the efficacy and safty of epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)with radiation therapy(RT)combined with EGFR-TKI in the treatment of non-small cell lung cancer(NSCLC)with brain metastases by using meta-analysis.METHODS: Before making this article,we used a personal computer to search the Chinese database(Wanfang,cnki.net)and the foreign language database(Embase,Pubmed)for Collecting literatures,which study about the epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)alone treatment therapy and radiotherapy(RT)combined with EGFR-TKI treatment therapy for non-small cell lung cancer(NSCLC)with brain metastases.The search time range was from the beginning of each database establishment to April 19 of 2018.In terms of literature quality evaluation,we used the Newcastle-Ottawa Scale,the combination of odds ratio(OR)and 95% confidence interval(95% CI)as indicators.We used RevMan 5.3 software to analyze the data.RESULTS: After searching Chinese and foreign language databases by computer,a total of 314 initial documents were retrieved.The two authors independently screened the literature according to the inclusion exclusion criteria,10 articles finally reached the standard.A total of 897 patients were included in this study.The results showed that the patients' DCR of EGFR-TKI combined with RT(n = 446)was significantly higher than who treated with EGFR-TKI alone(n = 451).The results were statistically significant(OR: 3.13,95% CI2.19 ~ 4.49,P <0.00001).There is no differece found between two treatment measures in OS(HR: 0.85,95% CI 0.68 ~ 1.07,P = 0.16)and PFS(HR: 1.06,95% CI 0.53 ~ 2.15,P = 0.86).However,the results showed that nPFS is Statistically significant(HR: 0.73,95% CI 0.62 ~ 0.86,P = 0.0001),suggesting that EGFR-TKI combined with radiotherapy may prolong the patient's nPFS.In addition,in patients with advanced NSCLC with brain metastases,the incidence of adverse reactions such as nausea and vomiting was significantly higher in patients treated with EGFR-TKI plus RT compared with EGFR-TKI monotherapy(P = 0.005);There was no significant difference in skin rash,diarrhea,and liver function damage between the two groups(P>0.05).CONCLUSION: The use of EGFR-TKI combined with radiotherapy for brain metastasis of non-small cell lung cancer is superior to the use of EGFR-TKI monotherapy in patients' s DCR and nPFS,but there is no significant difference in OS and PFS.At the same time,patients in the combination treatment group may have increased side effects such as nausea and vomiting due to treatment,but these adverse reactions can be tolerated by the treatment..