| Objective: To compare the effects of anti-angiogenesis drugs combined with brain radiotherapy on brain edema and brain metastases of non-small cell lung cancer with different EGFR gene status,and to compare the effects of combined anti-angiogenesis therapy on survival.Methods: Patients with brain metastasis from non-small cell lung cancer diagnosed by pathology and imaging were given whole brain radiotherapy or whole brain radiotherapy combined with stereotactic radiosurgery.Patients with EGFR mutation were treated with TKI at the same time.According to the severity of clinical manifestations of brain metastasis and the wishes of patients and their relatives,patients were given simultaneous combination of endostatin(recombinant human endostatin)or bevacizumab.A prospective clinical controlled trial was conducted to compare the volume changes of brain edema and brain metastases before and after radiotherapy,and OS was followed up.Reuslts:(1)After treatment,the average volume of brain edema and brain metastases in all patients decreased compared with that before radiotherapy.In group A,the volume of brain edema decreased from(106.23±62.04)cc to(20.97±35.88)cc,with an average decrease of(85.26±80.99)cc,(P=0.032,P<0.05),and the volume of brain metastases decreased from(8.73±5.83)cc to(3.86+4.43)cc,with an average decrease of(4.87±3.90),(P=0.016,P<0.05).In group B,the volume of brain edema decreased from(158.28±105.61)cc to(117.90±104.73)cc,with an average decrease of(40.38±67.68)cc(P=0.319,P>0.05),and the volume of brain metastases decreased from(10.13±7.87)cc to(7.78±5.79)cc,with an average decrease of(2.35±5.66)cc,(P=0.468,P>0.05).In group C,the volume of brain edema decreased from(92.37±64.65)cc to(40.21±42.05)cc,with an average decrease of(52.16 ±47.30)cc(P=0.011,P<0.05),and the volume of brain metastases decreased from(14.13±8.09)cc to(6.47±4.21)cc,with an average decrease of(7.67±6.09)cc,(P=0.005,P<0.05).In group D,the volume of brain edema decreased from(103.98±84.28)cc to(59.56±49.60)cc,with an average decrease of(44.42±83.67)cc,(P=0.301,P>0.05),and the volume of brain metastases decreased from(12.76±12.85)to(4.64±3.84)cc,with an average decrease of(8.12±9.86),(P=0.139,P>0.05).(2)The median OS of combined antivascular drugs and non-combined antivascular drugs were 15.9 and 31.4 months respectively(P=0.029).The median OS of mutant brain metastasis and wild brain metastasis were 24.2 months and 18.4 months respectively(P=0.733).The median OS of WBRT+SRS group and WBRT group were 26.1 months and 15.9 months respectively(P=0.306).In patients with EGFR mutations,the median OS of combined anti-angiogenic drugs and non-combined anti-angiogenic drugs were 15.3 months and24.2 months respectively(P=0.09).(3)Follow-up 1 month later,there were 6 cases(54.55%)of CR+PR,4 cases(36.36%)of SD and 1 case(9.09%)of PD in the combined antivascular drug group(n=11),6 cases(42.86%)of CR+PR in the non-combined antivascular drug group(n=14),8 cases(57.14%)of SD and 0 cases of PD.Conclusion: Anti-angiogenic drugs combined with brain radiotherapy can improve the short-term efficacy of brain metastasis of non-small cell lung cancer,effectively reduce the volume of brain edema and control brain metastasis,especially in patients with EGFR mutation combined with TKI and brain metastasis accompanied by severe brain edema.Anti-angiogenic drugs combined with brain radiotherapy did not benefit the survival of patients with brain metastases from non-small cell lung cancer. |
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