Retrospective Study Of The Efficacy Of EGFR-TKI Combined With Concurrent Brain Radiotherapy And TKI Alone In The Treatment Of Patients With Lung Adenocarcinoma With EGFR Mutation

Background: The treatment strategy remains controversial for brain metastasis(BM)in patients with EGFR-mutant lung adenocarcinoma(LAC).Based on the fact that brain radiotherapy is the main treatment for brain metastasis,and TKI is a valid treatment for lung adenocarcinoma with EGFR-mutation,In the present study,we compared the efficacy of brain radiotherapy(RT)in combination with tyrosine kinase inhibitors(TKI)and TKI alone for advanced LAC patients with epidermal growth factor receptor(EGFR)mutations and BM.Methods: We retrospectively studied 78 patients diagnosed with EGFR-mutant LAC who developed BM.These patients were divided into two groups.There were 49 patients in the combination treatment group,who were treated with brain RT in combination with EGFR-TKI(including 23 patients with asymptomatic BM before RT).There were 29 patients in the TKI group,who were given EGFR-TKI targeted therapy alone(including 22 patients with asymptomatic BM before TKI treatment).Results: The median intracranial progression-free survival(iPFS)of the combination treatment group was longer than that in the TKI alone group,which was 21.5 and 15 months(P = 0.036).However,there were no significant differences in median PFS(PFS)(12.0 versus 13.0 months;P=0.242)and median overall survival(mOS)(36 versus 23 months;P = 0.363)between the two groups.Further analysis of asymptomatic BM showed that the median iPFS of the combination treatment group and TKI alone group was 21.5 and 14.8 months(P=0.026),and the mOS was 36 and 23 months(P=0.041).Cox multivariate regression analysis found no independent adverse predictors of iPFS in all patients.Conclusions: The synchronous combination of brain RT and TKI was superior to EGFR-TKI alone for EGFR-mutant LAC patients with BM.The combination treatment group exhibited longer iPFS,while the PFS and OS were not significantly different between the two groups.In addition,the combination treatment might result in better iPFS and OS in those with asymptomatic BM.Therefore,addition of brain RT was useful for intracranial metastatic lesions.