全脑放疗时间对EGFR突变非小细胞肺癌脑转移患者生存的影响  

Timing of Whole Brain Radiotherapy on Survival of Patients with EGFR-mutated Non-small Cell Lung Cancer and Brain Metastases

作　　者：刘桂梅[1] 张新勇[2] 田翠孟[1] 夏广荣[1] 刘平[2] 张权[2] 李曦[2] 张卉[2] 秦娜[2] 王敬慧[2] 张树才[2] 

机构地区：[1]首都医科大学附属北京胸科医院,北京市结核病胸部肿瘤研究所放疗科,北京101149 [2]首都医科大学附属北京胸科医院,北京市结核病胸部肿瘤研究所肿瘤内科,北京101149

出　　处：《中国肺癌杂志》2016年第8期501-507,共7页Chinese Journal of Lung Cancer

摘　　要：背景与目的全脑放疗(whole brain radiotherapy,WBRT)在表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移患者治疗中何时应用尚无高级别的循证医学证据。本研究旨在探讨WBRT的参与时间对携有EGFR突变的NSCLC脑转移患者生存的影响。方法 2009年8月-2015年5月在我院确诊的EGFR突变伴脑转移的晚期NSCLC共78例患者,均接受WBRT及EGFR酪氨酸激酶抑制剂(EGFR tyrosine kinase inhibitors,EGFR-TKIs)治疗的48例初治患者进入临床分析,采用Cox比例风险模型分析患者颅内无进展生存期(progression-free survival,PFS)及总生存期(overall survival,OS)的影响因素。结果全组患者颅内客观缓解率(objective response rate,ORR)为81.3%,颅内疾病控制率(disease control rate,DCR)为93.8%,中位颅内PFS为10个月,中位OS为18个月。颅内PFS的多因素分析显示,美国东部肿瘤协作组评分(Eastern Cooperative Oncology Group performance status,ECOG PS)0分-1分(HR=30.436,95%CI:4.721-196.211,P<0.001)及早期WBRT患者(HR=3.663,95%CI:1.657-8.098,P=0.001)的颅内PFS更佳。OS的多因素分析显示,ECOG PS 0分-1分(HR=57.607,95%CI:6.135-540.953,P<0.001)、早期WBRT(HR=2.757,95%CI:1.140-6.669,P=0.024)及立体定向放射外科(stereotaxic radio surgery,SRS)的应用(HR=5.964,95%CI:1.895-18.767,P=0.002)是患者OS的独立预后因素。结论早期WBRT联合TKIs治疗可改善EGFR突变的NSCLC脑转移患者的预后,尚有待大样本的前瞻性临床试验验证。Background and objective There is no high-level evidence for the time of whole brain radiotherapy（WBRT） for patients with epidermal growth factor receptor（EGFR）-mutated non-small cell lung cancer（NSCLC） and brain metastases. The aim of this study is to assess the appropriate timing of WBRT for patients with EGFR-mutated NSCLC and brain metastases（BM）. Methods There were 78 patients diagnosed with EGFR-mutated NSCLC and BM in Beijing Chest Hospital between August 2009 and May 2015. 48 untreated patients who received both WBRT and EGFR-tyrosine kinase inhibitors（TKIs） therapy. Prognostic factors of intracranial progression-free survival（PFS） and overall survival（OS） were identified by Cox proportional hazards modeling. Results Intracranial objective response rate was 81.3% and disease control rate was 93.8%. Median intracranial PFS was 10 months. Median OS was 18 months. Multivariate analysis of intracranial PFS revealed that Eastern Cooperative Oncology Group（ECOG） performance status（PS） 0-1（HR=30.436, 95%CI： 4.721-196.211, P〈0.001） and early WBRT（HR=3.663, 95%CI： 1.657-8.098, P=0.001） had a better intracranial PFS. Multivariate analysis of OS revealed that PS 0-1（HR=57.607, 95%CI： 6.135-540.953, P〈0.001）, early WBRT（HR=2.757, 95%CI： 1.140-6.669, P=0.024）, and stereotactic radiosurgery（HR=5.964, 95%CI： 1.895-18.767, P=0.002） were independent prognostic factors of OS. Conclusion Early WBRT combined with EGFR-TKIs can improve outcomes of patients with EGFR-mutated NSCLC and BM, but it needs to be confirmed by large-sample-size and multicenter prospective clinical trials.

关 键 词：全脑放疗 酪氨酸激酶抑制剂 表皮生长因子受体突变 肺肿瘤 脑转移 

分 类 号：R734.2[医药卫生—肿瘤]