The Analysis Of Prognosis Factors In Radiotherapy And Survival Analysis Of Combined Therapy To Patients Diagnosed With Lung Adenocarcinoma With Brain Metastatic Symptoms

Objective:Intensity modulated radiotherapy(IMRT)is one of the most important methods for the local treatment of lung adenocarcinoma with brain metastasis.The one of main purpose of this paper is to explore the survival of patients with brain metastasis from lung adenocarcinoma treated by Intensity-modulated radiotherapy and the factors that affect the prognosis.Another purpose is to compare the efficacy of craniocerebral radiotherapy combined with different systemic treatments,for providing suggestions for the option of different combination therapies for patients with brain metastasis of lung cancer.Methods:We collected the clinical characteristics of 86 patients who were diagnosed with lung adenocarcinoma with brain metastasis and treated with IMRT between November 2016 and January 2020 in Jinan Central Hospital.Subsequently,the follow-up was conducted by consulting the medical record system and making telephone calls until February 6,2021.All statistical analysis was conducted by SPSS22.0(IBM Corp,Armonk,NY,USA).Survival analysis was performed by Kaplan-Meier method.For univariate and multivariate analysis,we used Log-rank test and Cox proportional hazard regression respectively,with P<0.05 for statistically significant.Results:A total of 86 patients diagnosed with lung adenocarcinoma with BMs were included in the analysis.By the deadline for follow-up,69 people had died and the median follow-up time was 12.2 months(95%CI,10.1-14.3).The median overall-survival time was 12.2 months(95%CI,9.5-14.9)and survival rate at 6,12,18,and 24 months after radiotherapy was 68.6%,50.5%,28.4%and 23.1%respectively;The median intracranial progression-free survival was 7.4 months(95%CI,5.2-9.7)and survival rate at 6,12,18,and 24 months after radiotherapy was 60.5%,28.8%、13.1%and 4.9%respectively.The objective remission rate was 28,7%and the disease control rate was 91.3%.The multivariate survival analysis showed that KPS score,T stage,N stage,control of extracranial lesions and history of targeted therapy influenced the iPFS independently and KPS score,N stage,EGFR mutation status,control of extracranial lesions and Lung-mol GPA score influenced the OS independently.The median iPFS in patients with EGFR mutation type receiving the therapy of radiotherapy combined with EGFR-TKI targeted,radiotherapy combined with chemotherapy and radiotherapy alone was 11.2 months,9.6 months and 5.0 months respectively,and the difference wasn’t statistically significant(P=0.059).The median OS of patients treated with three therapeutic plans was 18.9 months,12.5 months,11.9 months,the difference was statistically significant(P=0.033).The median iPFS in patients with EGFR wild type receiving the therapy of radiotherapy combined with targeted,radiotherapy combined with chemotherapy,radiotherapy alone was 11.1 months,6.7months,3.1 months and 11.9 months respectively,and the difference was statistically significant(P=0.003).The median OS of patients treated with three therapeutic plans was 11.2 months,11.6 months,3.1 months respectively,the difference was statistically significant(P=0.019).Conclusion:Patients with high KPS score,high Lung-mol GPA score,EGFR mutation,stable extracranial lesions and at the early N staging could achieve better intracranial control time and longer survival after radiotherapy.Compared with radiotherapy alone or radiotherapy combined with chemotherapy,craniocerebral radiotherapy combined with EGFR-TKI targeted therapy for the patients with EGFR mutation type will achieve better therapeutic effect.Under same situation,craniocerebral radiotherapy combined with multi-target TKI therapy for the patients with EGFR wild type will also result in better therapeutic efficacy.