论文部分内容阅读
目的探讨表皮生长因子受体(EGFR)突变阳性、无症状脑转移的非小细胞肺癌(NSCLC)患者脑部放疗(BRT)的最佳时机。方法选取50例初诊无症状脑转移的EGFR突变阳性的肺腺癌患者,分析其治疗方案、疗效以及失败模式。结果 50例患者的中位随访时间为26个月,2年总生存率为44.0%,预期生存时间为21个月。单因素分析显示ECOG评分、颅外转移灶、一线全身治疗方案与总生存期显著相关。多因素分析显示仅颅外转移灶与总生存期相关。所有患者2年脑转移无进展生存率为29.3%,预期时间为19个月。BRT时机与脑转移无进展生存时间无明显相关性。结论对于无症状脑转移的EGFR突变阳性的NSCLC患者,一线BRT无明显生存获益,一线应用酪氨酸激酶抑制剂基础上延迟BRT可能是较好的治疗选择。
Objective To investigate the optimal timing of brain radiotherapy (BRT) in patients with positive EGFR mutation and non-metastatic non-small cell lung cancer (NSCLC). Methods Fifty patients with newly diagnosed lung adenocarcinoma who had EGFR mutation positive asymptomatic brain metastasis were selected and their treatment regimen, efficacy and failure mode were analyzed. Results The 50 patients had a median follow-up of 26 months, a 2-year overall survival rate of 44.0% and a prospective survival of 21 months. Univariate analysis showed that ECOG score, extracranial metastases, first-line systemic treatment regimens were significantly associated with overall survival. Multivariate analysis showed that only extracranial metastases correlated with overall survival. The 2-year progression-free survival of brain metastases was 29.3% in all patients and the expected time was 19 months. There was no significant correlation between BRT timing and progression-free survival time of brain metastases. Conclusions There is no significant survival benefit for first-line BRT in NSCLC patients with EGFR mutation without asymptomatic brain metastases. Delayed BRT based on tyrosine kinase inhibitor may be a better treatment option for first-line NSCLC patients with asymptomatic brain metastasis.