Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

Guangchuan Deng; Xiaojing Tan; Yankang Li; Yingyun Zhang; Qi Wang; Jianbin Li; Zhenxiang Li

doi:10.3389/fonc.2023.1049855

Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

Front Oncol. 2023 Feb 9:13:1049855. doi: 10.3389/fonc.2023.1049855. eCollection 2023.

Authors

Guangchuan Deng^{1

2}, Xiaojing Tan³, Yankang Li², Yingyun Zhang^{1

2}, Qi Wang^{1

2}, Jianbin Li², Zhenxiang Li²

Affiliations

¹ School of Graduate Studies, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
² Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
³ Department of Oncology, Dongying People's Hospital, Dongying, China.

Abstract

Background and purpose: Epidermal growth factor receptor (EGFR)-mutant lung cancers are associated with a high risk of developing brain metastases (BM). Craniocerebral radiotherapy is a cornerstone for the treatment of BM, and EGFR-TKIs act on craniocerebral metastases". However, whether EGFR-TKIs combined with craniocerebral radiotherapy can further increase the efficacy and improve the prognosis of patients is unclear. This study aimed to evaluate the difference in efficacy between targeted-therapy alone and targeted-therapy combined with radiotherapy in EGFR-mutant lung adenocarcinoma patients with BM.

Materials and methods: A total of 291 patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutations were enrolled in this retrospective cohort study. Propensity score matching (PSM) was conducted using a nearest-neighbor algorithm (1:1) to adjust for demographic and clinical covariates. Patients were divided into two groups: EGFR-TKIs alone and EGFR-TKIs combined with craniocerebral radiotherapy. Intracranial progression-free survival (iPFS) and overall survival (OS) were calculated. Kaplan-Meier analysis was used to compare iPFS and OS between the two groups. Brain radiotherapy included WBRT, local radiotherapy, and WBRT+Boost.

Results: The median age at diagnosis was 54 years (range: 28-81 years). Most patients were female (55.9%) and non-smokers (75.5%). Fifty-one pairs of patients were matched using PSM. The median iPFS for EGFR-TKIs alone (n=37) and EGFR-TKIs+craniocerebral radiotherapy (n=24) was 8.9 and 14.7 months, respectively. The median OS for EGFR-TKIs alone (n=52) and EGFR-TKIs+craniocerebral radiotherapy (n=52) was 32.1 and 45.3 months, respectively.

Conclusion: In EGFR-mutant lung adenocarcinoma patients with BM, targeted therapy combined with craniocerebral radiotherapy is an optimal treatment.

Keywords: Adenocarcinoma of lung; brain neoplasms; carcinoma; non-small-cell lung; progression-free survival (PFS).

Grants and funding

This study was supported jointly by Taishan Scholars Program of Shandong Province (No. ts20190982), the National Natural Science Foundation of China (Grant No. 82272752). And there are no competing interests.