Impact of Radiotherapy Pattern on the Prognosis of Stage IV Lung Adenocarcinomas Harboring EGFR Mutations

Yingyun Zhang; Wei Wang; Xuedong Xu; Yankang Li; Hui Zhang; Jianbin Li; Zhenxiang Li

doi:10.2147/CMAR.S299563

Impact of Radiotherapy Pattern on the Prognosis of Stage IV Lung Adenocarcinomas Harboring EGFR Mutations

Cancer Manag Res. 2021 Apr 15:13:3293-3301. doi: 10.2147/CMAR.S299563. eCollection 2021.

Authors

Yingyun Zhang^{1

2}, Wei Wang^{1

2}, Xuedong Xu^{1

2}, Yankang Li^{1

3}, Hui Zhang⁴, Jianbin Li^{1

2}, Zhenxiang Li¹

Affiliations

¹ Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China.
² Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
³ Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.
⁴ Tumor Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, Jishou, People's Republic of China.

Abstract

Introduction: The aim of this study was to investigate the role of local radiotherapy in the management of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancers (NSCLCs) treated with EGFR tyrosine kinase inhibitors (TKIs).

Materials and methods: Patients with stage IV EGFR-mutant NSCLC treated with radiotherapy concomitant to EGFR TKIs from May 2010 to December 2017 were retrospectively identified. Overall survival (OS) was the primary endpoints of the study.

Results: A total of 205 patients were enrolled in the study. One hundred eleven patients received one-time single-site radiotherapy (SSR), and 94 patients received multiple-site radiotherapy (MSR). Patients who received MSR had longer OS (median OS, 40.0 months; 95% confidence interval [CI], 29.6 to 50.4) than those who received SSR (median OS, 28.9 months; 95% CI, 24.3 to 33.5; P=0.031). Thoracic radiotherapy was associated with prolonged median OS (41.7 months, 95% CI, 29.0 to 54.4 vs 27.1 months, 95% CI 22.7 to 31.5; log-rank P<0.001). Multivariate analysis confirmed that thoracic radiotherapy was independently associated with improved OS (adjusted hazard ratio [HR], 0.514; 95% CI 32.3% to 81.8%; P=0.005).

Conclusion: MSR improves survival outcomes in patients with advanced-stage, EGFR-mutant, lung adenocarcinoma, with thoracic radiotherapy having the most significant effect on prognosis.

Keywords: EGFR; adenocarcinomas; advanced-stage lung cancer; radiotherapy.

Grants and funding

This study was supported jointly by the national natural science foundation of China (Grant No. 81602031), the National Key Research Program of China (No. 2016YFC0904700), Shandong natural science foundation (Grant No. ZR2016HB12) and the national natural science foundation of China (Grant No. 81703038).