Observation Of The Efficacy Of Icotinib Combined With Thoracic Radiotherapy In The Treatment Of Advanced NSCLC With EGFR Mutations

Objective To evaluate the effectiveness and toxicity of ectinib combined with concurrent chest-radiotherapy for the treatment of advanced non-small cell lung cancer in IIIB/ⅣA stages with EGFR mutation.Methods A total of 64 patients with EGFR-mutated NSCLC in IIIB/Ⅳ stages who were treated in our hospital from June 2014 to February 2019 were randomly divided into TKI group(standard group)and TKI+RT group(study group).1.The tTKI group was treated with ectinib(125 mg tid)until the tumor progressed or could not tolerate the toxicity.2.TKI+RT group was treated with ectinib(125 mg tid),combined with concurrent chest-radiotherapy 1 week later,continuing with ectinib after radiotherapy until he tumor progressed or could not tolerate the toxicity.Radiotherapy: GTV: The primary tumor size(including primary lesion,mediastinal metastatic lymph node,intrapulmonary metastases)indicated by CT mimic map is GTV,and the short burr edge of lesion is included in the GTV;CTV: Unless there is a clear tumor invasion,conventionally,GTV is expanded 8mm in all directions,not exceed the anatomical boundaryand,no irradiation of the lymphatic drainage area;PTV: on the basis of CTV,according to the location of the tumor,5mm in the front,back,left and right directions,8-10 mm in the upper and lower directions for the placement error;Dose: 95%PTV 6000~6600cGy/~33F,5F/week.OARs: Includes the lungs,spinal cord,heart,and esophagus.The radiotherapy program was developed using the MONACO 5.1 planning system and IMRT irradiation technology.3.All patients were examined for blood routine examination,liver and kidney function,tumor markers,electrocardiogram,etc.during the medication,and the side effects were observed,and the tumor was examined by imaging.Results In the TKI group,1 case of CR,16 cases of PR,and 10 cases of SD,the total effective rate of treatment was 53.1%(17/32),the local control rate was 78.1%(27/32);3 cases of CR in TKI+RT group,20 cases of PR and 6 cases of SD;the total effective rate of treatment was 71.8%(23/32),and the local control rate was 90.6%(29/32).The median progression-free survival was 13 months in the TKI group and 18 months in the TKI+RT group.There was no significant difference in the incidence of rash,diarrhea,nausea,vomiting,fatigue,anemia,and myelosuppression in patients with TKI and TKI+RT.Only one grade 3 radiation pneumonitis occurred in the TKI+RT group and improved after treatment.Conclusion Compared with EGFR-TKI alone,EGFR-TKI treatment combined with concurrent chest radiotherapy can achieve better short-term and long-term effects,and the adverse reactions are not significantly increased.