EGFR突变肺癌脑转移在三代靶向药物时代的早放疗价值  

Value of early radiotherapy for EGFR mutation-positive non-small cell lung cancer with brain metastasis in the era of third-generation targeted drugs:a single center retrospective study of 85 cases

作　　者：吴俊兰[1] 潘绵顺[1] 马兆明 刘海涛 李勇[1] 邵显军 魏燕[3] 岳倩 Wu Junlan;Pan Mianshun;Ma Zhaoming;Liu Haitao;Li Yong;Shao Xianjun;Wei Yan;Yue Qian(Tumor Radiology Diagnosis and Treatment Center,Shanghai Armed Police Corps Hospital,Shanghai 201103,China;Department of Radiation Oncology,Lianyungang Tumor Hospital,Lianyungang 222006,China;Second Internal Department,Shanghai Armed Police Corps Hospital,Shanghai 201103,China)

机构地区：[1]武警上海总队医院肿瘤放射诊疗中心,上海201103 [2]连云港市肿瘤医院放疗科,连云港222006 [3]武警上海总队医院内二科,上海201103

出　　处：《中华放射肿瘤学杂志》2024年第3期212-217,共6页Chinese Journal of Radiation Oncology

摘　　要：目的探讨表皮生长因子受体基因(EGFR)突变阳性非小细胞肺癌脑转移患者在三代靶向药物时代的放疗合理时机。方法回顾性分析2019年9月—2022年5月,在武警上海总队医院肿瘤放射诊疗中心诊治的EGFR突变阳性并接受过三代靶向药物一线治疗和立体定向放疗的非小细胞肺癌脑转移患者资料。依据放疗时机在靶向药物耐药前/后,将患者分为脑放疗早参与组与晚参与组。比较两组患者的脑转移比例、体能状态、完全缓解率、客观缓解率、延迟脑转移进展的时间、总生存(OS)。用Kaplan-Meier法进行生存分析,用log-rank法进行单因素预后分析,将P<0.1的因素纳入Cox多因素分析。结果共纳入85例患者,其中51例(60%)为早放疗患者。脑放疗早参与组较晚参与组有更高的症状性脑转移比例(82%∶56%,P=0.013),更差的体能状态(卡诺夫斯凯计分<70分者为61%∶27%,P=0.002)。脑放疗早参与显著提高颅内病灶完全缓解率(35%∶12%,P=0.015)和客观缓解率(88%∶71%,P=0.041),延迟脑转移进展的时间(中位颅内无疾病进展时间为23.0∶16.0个月,P=0.005;中位颅内无二次进展生存时间为31.0∶22.0个月,P=0.021),并改善患者OS(中位OS时间为44.0∶35.0个月,P=0.046)。多因素分析中,诊断特异性预后评估分级评分<2.5、21号外显子突变、脑放疗晚参与是OS的预后不良因素。结论在三代靶向药物治疗时代,非小细胞肺癌脑转移患者靶向药物耐药前进行立体定向放疗,有更大临床获益。Objective To explore the reasonable timing of radiotherapy for epidermal growth factor receptor(EGFR)mutation-positive non-small cell lung cancer patients with brain metastasis in the era of third-generation targeted drugs.Methods Clinical data of EGFR mutation-positive non-small cell lung cancer patients with brain metastasis who received first-line treatment with third-generation targeted drugs and stereotactic radiotherapy at Shanghai Armed Police Corps Hospital from September 2019 to May 2022 were retrospectively analyzed.According to the timing of radiotherapy before/after targeted drug resistance,all patients were divided into the early and salvage radiotherapy groups.The proportion of brain metastasis,physical fitness,complete response rate,objective response rate,delaying the progression of brain metastasis and overall survival(OS)were compared between two groups.Kaplan-Meier method was used for survival analysis,log-rank test was used for univariate prognostic analysis,and factors with P<0.1 were included in Cox multivariate analysis.Results A total of 85 patients were included,including 51(60%)cases receiving early radiotherapy.Patients who participated in early radiotherapy had a higher proportion of symptomatic brain metastasis(82%vs.56%,P=0.013)and poorer physical fitness(Kanofsky performance score<70:61%vs.26%,P=0.002)compared to patients who underwent salvage radiotherapy.Early radiotherapy significantly improved the complete response rate of intracranial lesions(35%vs.12%,P=0.015)and objective response rate(88%vs.71%,P=0.041),delayed the progression of brain metastasis(median intracranial progression free survival:23.0 months vs.16.0 months,P=0.005;median intracranial secondary progression free survival:31.0 months vs.22.0 months,P=0.021),and improved OS(median OS:44.0 months vs.35.0 months,P=0.046).In multivariate analysis,diagnosis-specific graded prognostic assessment score<2.5,mutation of EGFR exon 21,and salvage brain radiotherapy were adverse prognostic factors for OS.Conclusion In the era o

关 键 词：癌 非小细胞肺 脑转移 表皮生长因子受体基因突变 三代靶向药物 立体定向放射疗法 

分 类 号：R734.2[医药卫生—肿瘤]