Prognostic Analysis Of EGFR Mutation Positive NSCLC With Brain Metastases After EGFR-TKI Combined Stereotactic Radiotherapy

ObjectiveThis study was conducted by taking the initial treatment of EGFR mutation positive on non-small cell lung cancer(NSCLC)patients with brain metastases as the research object,to analyze relevant clinical data of patients of EGFR mutant positive NSCLC with brain metastases cured by EGFR-TKI combine stereotactic radiotherapy and EGFR-TKI monotherapy,and to explore the benefits and related risks of EGFR mutation positive NSCLC with brain metastases patients after EGFR-TKI combined stereotactic radiotherapy.Methods53 cases of initial treatment of EGFR mutant positive on NSCLC patients with brain metastases were collected in our hospital from January 2014 to October 2017 and 12 cases were excluded after screening.The enrolled patients TNM staging were IVA or IVB,which were divided into two groups according to the treatment method.The therapeutic group was treated with EGFR-TKI three months evaluating curative effect,the efficacy evaluation of intracranial lesion and extracranial lesion was in complete response(CR),EGFR-TKI was continued.Stereotactic radiotherapy was given to partial response(PR),stability disease(SD),progress disease(PD)and EGFR-TKI was continued,until the progress of the disease;The control group was treated with the EGFR-TKI monotherapy,until the progress of the disease.The control of local lesions in two groups were analyzed at three months and six months(after the combined stereotactic radiotherapy was conducted),thus to further analyze survival benefits and prognostic factors of EGFR-TKI combined stereotactic radiotherapy.Results1.The efficacy evaluation was conducted after being treated with EGFR-TKI at three months.The objective response rate(ORR)of patients from two groups was of 52% vs.57% and disease control rate(DCR)was of 81 %vs.85%.Through the statistical analysis of ORR and DCR in two groups,the results showed no significant difference(P>0.05).The efficacy evaluation at six months(after the combined stereotactic radiotherapy was conducted)indicated that ORR and DCR of the patients from two groups was respectively 84% vs.60% and 96% vs.84%.Through the statistical analysis,the differences in ORR and DCR were statistically significant(P<0.05).2.Univariate survival analysis revealed that age,gender,KPS score,EGFR mutation type,and EGFR-TKI drug type of EGFR mutant positive NSCLC patients with brain metastases were not related to patients progression-free survival.The metastatic sites,treatment methods,and the number of lesion with brain metastases were related to the prognosis of patients with EGFR positive NSCLC with brain metastases.3.The results of multivariate analysis suggested that the treatment methods,metastatic sites,and the number of lesion of the brain metastases were independent prognostic factors for patients with EGFR positive NSCLC with brain metastases;Namely,the progression-free survival time for those patients treated with EGFR-TKI combined stereotactic radiotherapy was prolonged compared with that of patients treated with EGFR-TKI monotherapy.The progression-free survival time of patients with the number of intracranial metastases < 3 was prolonged compared with those ones with the number of intracranial metastases ≥3.The progression-free survival time for independent intracranial metastases was prolonged compared with that of the intracranial and extracranial metastases.Conclusion1.For patients of EGFR mutation positive NSCLC with brain metastases treated with EGFR-TKI,the stereotactic radiotherapy for timely intervention on the efficacy evaluation PR、SD and PD tumor lesion with EGFR-TKI treatment was conducted,the patients systemic tumor load were reduced,the patients progression free survival was extended.2.For patients of EGFR mutation positive NSCLC with brain metastases treated with EGFR-TKI,the stereotactic radiotherapy for timely intervention on the efficacy evaluation PR 、 SD and PD tumor lesion with EGFR-TKI treatment was conducted,EGFR-TKI resistance was prolonged,and combined therapy may reduce the risk of tumor cell invasion and metastasis.3.Metastatic sites and the number of brain metastases were the independent risk factor for the patient’s condition.The more metastatic sites,the larger the number of brain metastases,the worse the patient’s prognosis.4.EGFR-TKI combined stereotactic radiotherapy received a mild adverse reaction.