Cranial Irradiation for Patients with Epidermal Growth Factor Receptor (EGFR) Mutant Lung Cancer Who Have Brain Metastases in the Era of a New Generation of EGFR Inhibitors
Journal
Oncologist
Journal Volume
24
Journal Issue
12
Pages
e1417-e1425
Date Issued
2019
Author(s)
Abstract
Background: Immediate whole brain radiation (WBRT) has been the standard for patients with lung cancer with brain metastases. The study aims to evaluate the effect of immediate cranial irradiation in patients with epidermal growth factor receptor (EGFR) mutant lung cancer in the era of a new generation of EGFR inhibitors. Materials and Methods: Medical records of 198 patients with EGFR mutant non-small cell lung cancer and brain metastases at initial metastatic diagnosis were reviewed. Patients were categorized into four groups: immediate WBRT, immediate cranial stereotactic radiosurgery (SRS), delayed radiation upon progression of cranial lesions (DRT), and never cranial irradiation (NRT). Overall survival (OS) and progression-free survival related to EGFR inhibitors were analyzed. Results: The SRS group had the fewest brain metastases and fewest extracranial lesions, and the DRT and NRT groups had the smallest brain metastases. Median survival were 18.5, 55.7, 21.1, and 18.2 months for the WBRT, SRS, DRT, and NRT groups, respectively. Patients who had received EGFR T790M inhibitors survived longer (41.1 vs. 19.8 months). In multivariate analysis, the OS of patients in the SRS group was longer than that in the NRT group (adjusted hazard ratio [aHR]: 0.315). Patients who had fewer extracranial lesions and who had received EGFR T790M inhibitor treatments also survived longer (aHR: 0.442 and 0.357, respectively). Conclusion: Immediate stereotactic radiosurgery but not whole brain radiation was associated with longer survival. Because of patient heterogeneity and the introduction of EGFR T790M inhibitors, the timing and modality of cranial irradiation should be determined individually, and cranial irradiation may be omitted for selected patients. Implications for Practice: Immediate whole brain radiation has been the standard for patients with lung cancer with brain metastases. In this study, it was observed that, for patients with epidermal growth factor receptor (EGFR) mutant advanced lung cancer who had brain metastases, there was no difference in survival between patients who never received cranial irradiation and those who received whole brain radiation immediately. Patients who received immediate stereotactic radiosurgery or who had ever received EGFR T790M inhibitors survived longer. Patients who received immediate stereotactic radiosurgery have fewer brain metastases. These findings suggest that the timing and modality of cranial irradiation should be determined individually, and cranial irradiation may be omitted in selected patients. ? AlphaMed Press 2019
SDGs
Other Subjects
azd 9191; epidermal growth factor receptor; epidermal growth factor receptor kinase inhibitor; hs 10296; nazartinib; rociletinib; t 790m; unclassified drug; epidermal growth factor receptor; protein kinase inhibitor; adenocarcinoma; adenosquamous carcinoma; adult; aged; Article; brain damage; brain metastasis; cancer staging; cancer survival; chemoradiotherapy; exon; female; gene deletion; gene mutation; human; lung cancer; major clinical study; male; non small cell lung cancer; overall survival; priority journal; progression free survival; radiation dose; skull irradiation; squamous cell lung carcinoma; stereotactic radiosurgery; whole brain radiotherapy; brain tumor; complication; lung tumor; middle aged; pathology; procedures; retrospective study; very elderly; Adult; Aged; Aged, 80 and over; Brain Neoplasms; Cranial Irradiation; ErbB Receptors; Female; Humans; Lung Neoplasms; Male; Middle Aged; Protein Kinase Inhibitors; Retrospective Studies
Publisher
Wiley-Blackwell
Type
journal article