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Whole brain radiation therapy does not improve the overall survival of EGFR-mutant NSCLC patients with leptomeningeal metastasis.
Radiat Oncol. 2019 Sep 14; 14(1):168.RO

Abstract

BACKGROUND

Leptomeningeal metastasis (LM) is a devastating and terminal complication of advanced non-small-cell lung cancer (NSCLC), especially in patients harboring epidermal growth factor receptor (EGFR) mutations. The role of whole brain radiation therapy (WBRT) in the treatment of EGFR-mutant NSCLC patients with LM is not conclusive. Therefore, we conducted a retrospective study to evaluate the therapeutic effect of WBRT in this setting.

METHODS

EGFR-mutant NSCLC patients with LM, who had previously received treatment at the Shandong Cancer Hospital and Institute from July 2014 to March 2018 were reviewed retrospectively. LM was diagnosed by positive CSF cytology and/or leptomeningeal-enhanced magnetic resonance imaging (MRI). Survival was estimated using the Kaplan-Meier method.

RESULTS

In total, 51 EGFR-mutated NSCLC patients with LM were eligible for analysis, subdivided into 26 in the WBRT group and 25 in the non-WBRT group. No significant differences were observed in intracranial ORR (15.4% vs. 16%, p = 0.952) and DCR (34.7% vs. 28%, p = 0.611) between the two groups. The median iPFSLM and OSLM for the entire cohort were 3.3 months (95% CI: 2.77-3.83) and 12.6 months (95% CI: 9.66-15.54), respectively. No difference in iPFSLM was observed between the WBRT and non-WBRT groups (median 3.9 vs. 2.8 months; HR = 0.506, p = 0.052). The median OSLM was 13.6 months in the WBRT group, compared with 5.7 months in the non-WBRT group (HR = 0.454, p = 0.022). Multivariate analyses of OSLM showed that KPS ≥ 80 at the time of LM diagnosis (HR = 0.428, 95% CI: 0.19-0.94; p = 0.034) and the administration of EGFR-TKIs (HR = 0.258, 95% CI: 0.11-0.58; p = 0.001) were independent predictors of survival, but WBRT (HR = 0.49, 95% CI: 0.24-1.01; p = 0.54) was not. Toxicities associated with WBRT or other treatment were rare.

CONCLUSION

For EGFR-mutated NSCLC patients with LM, WBRT did not improve intracranial treatment response and survival statistically.

Authors+Show Affiliations

School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China. drzhuh@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31521171

Citation

Yan, Weiwei, et al. "Whole Brain Radiation Therapy Does Not Improve the Overall Survival of EGFR-mutant NSCLC Patients With Leptomeningeal Metastasis." Radiation Oncology (London, England), vol. 14, no. 1, 2019, p. 168.
Yan W, Liu Y, Li J, et al. Whole brain radiation therapy does not improve the overall survival of EGFR-mutant NSCLC patients with leptomeningeal metastasis. Radiat Oncol. 2019;14(1):168.
Yan, W., Liu, Y., Li, J., Han, A., Kong, L., Yu, J., & Zhu, H. (2019). Whole brain radiation therapy does not improve the overall survival of EGFR-mutant NSCLC patients with leptomeningeal metastasis. Radiation Oncology (London, England), 14(1), 168. https://doi.org/10.1186/s13014-019-1376-z
Yan W, et al. Whole Brain Radiation Therapy Does Not Improve the Overall Survival of EGFR-mutant NSCLC Patients With Leptomeningeal Metastasis. Radiat Oncol. 2019 Sep 14;14(1):168. PubMed PMID: 31521171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Whole brain radiation therapy does not improve the overall survival of EGFR-mutant NSCLC patients with leptomeningeal metastasis. AU - Yan,Weiwei, AU - Liu,Yang, AU - Li,Ji, AU - Han,Anqin, AU - Kong,Li, AU - Yu,Jinming, AU - Zhu,Hui, Y1 - 2019/09/14/ PY - 2019/06/29/received PY - 2019/09/09/accepted PY - 2019/9/16/entrez PY - 2019/9/16/pubmed PY - 2020/2/15/medline KW - EGFR mutations KW - Leptomeningeal metastasis KW - Non-small cell lung cancer KW - Survival KW - Treatment response KW - WBRT SP - 168 EP - 168 JF - Radiation oncology (London, England) JO - Radiat Oncol VL - 14 IS - 1 N2 - BACKGROUND: Leptomeningeal metastasis (LM) is a devastating and terminal complication of advanced non-small-cell lung cancer (NSCLC), especially in patients harboring epidermal growth factor receptor (EGFR) mutations. The role of whole brain radiation therapy (WBRT) in the treatment of EGFR-mutant NSCLC patients with LM is not conclusive. Therefore, we conducted a retrospective study to evaluate the therapeutic effect of WBRT in this setting. METHODS: EGFR-mutant NSCLC patients with LM, who had previously received treatment at the Shandong Cancer Hospital and Institute from July 2014 to March 2018 were reviewed retrospectively. LM was diagnosed by positive CSF cytology and/or leptomeningeal-enhanced magnetic resonance imaging (MRI). Survival was estimated using the Kaplan-Meier method. RESULTS: In total, 51 EGFR-mutated NSCLC patients with LM were eligible for analysis, subdivided into 26 in the WBRT group and 25 in the non-WBRT group. No significant differences were observed in intracranial ORR (15.4% vs. 16%, p = 0.952) and DCR (34.7% vs. 28%, p = 0.611) between the two groups. The median iPFSLM and OSLM for the entire cohort were 3.3 months (95% CI: 2.77-3.83) and 12.6 months (95% CI: 9.66-15.54), respectively. No difference in iPFSLM was observed between the WBRT and non-WBRT groups (median 3.9 vs. 2.8 months; HR = 0.506, p = 0.052). The median OSLM was 13.6 months in the WBRT group, compared with 5.7 months in the non-WBRT group (HR = 0.454, p = 0.022). Multivariate analyses of OSLM showed that KPS ≥ 80 at the time of LM diagnosis (HR = 0.428, 95% CI: 0.19-0.94; p = 0.034) and the administration of EGFR-TKIs (HR = 0.258, 95% CI: 0.11-0.58; p = 0.001) were independent predictors of survival, but WBRT (HR = 0.49, 95% CI: 0.24-1.01; p = 0.54) was not. Toxicities associated with WBRT or other treatment were rare. CONCLUSION: For EGFR-mutated NSCLC patients with LM, WBRT did not improve intracranial treatment response and survival statistically. SN - 1748-717X UR - https://www.unboundmedicine.com/medline/citation/31521171/Whole_brain_radiation_therapy_does_not_improve_the_overall_survival_of_EGFR_mutant_NSCLC_patients_with_leptomeningeal_metastasis_ L2 - https://ro-journal.biomedcentral.com/articles/10.1186/s13014-019-1376-z DB - PRIME DP - Unbound Medicine ER -