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  • [Sci Rep .] Effect of whole-brain radiotherapy with platinum-based chemotherapy in non-small cell lung cancer patients with multiple metastases including brain metastases

    인하대병원 / 류우경, 류정선*, 임준혁*

  • 출처
    Sci Rep .
  • 등재일
    2023 Aug 14
  • 저널이슈번호
    13(1):13173. doi: 10.1038/s41598-023-40235-0.
  • 내용

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    Abstract
    Current guidelines recommend that cytotoxic chemotherapy be considered first in non-small cell lung cancer (NSCLC) patients with multiple metastases, and whole-brain radiotherapy (WBRT) is not initially recommended even if brain metastases are present. However, cytotoxic chemotherapeutic agents are less effective in brain metastases due to poor blood-brain barrier permeability. We investigated the effect of WBRT in combination with cytotoxic chemotherapy on survival in NSCLC patients who were EGFR, ALK, and PD-L1 negative, had an ECOG PS of 2, and had multiple metastases including brain metastases. From January 2005 to December 2018, histologically confirmed NSCLC patients who were EGFR, ALK, and PD-L1 negative, had an ECOG PS of 2, and had multiple metastases including brain metastases were included in this study. Patients were classified into two groups based on receiving WBRT prior to or concurrently with administration of first-line chemotherapeutic agents or receiving chemotherapy only. We compared intracranial progression-free survival (iPFS) and overall survival (OS). Of the 240 NSCLC patients with brain metastases at diagnosis and an ECOG PS of 2, 67 patients were EGFR, ALK, and PD-L1 negative with multiple metastases including brain metastases. Among those patients, 43 (64.2%) received WBRT prior to or concurrently with platinum-based chemotherapy. Patients who received WBRT prior to or concurrently with chemotherapy had better iPFS (7.7 months [4.8-10.6] vs. 3.5 months [2.1-4.9], p = 0.009) and OS (10.8 months [5.9-15.7] vs. 6.1 months [1.9-10.3], p = 0.038) than those who did not receive WBRT. In multivariate analyses, WBRT was significantly associated with iPFS (HR: 1.94 and 95% CI 1.11-3.40, p = 0.020) and OS (HR: 1.92 and 95% CI 1.08-3.42, p = 0.027). In NSCLC patients who are EGFR, ALK, and PD-L1 negative, have an ECOG PS of 2, and have multiple metastases including brain metastases, WBRT prior to or concurrently with chemotherapy could improve iPFS and OS. Therefore, the combination of WBRT with cytotoxic chemotherapy should be considered in these patients.

     

     

    Affiliations

    Woo Kyung Ryu # 1, Hyung Keun Cha # 1, Woochul Kim 2, Ha Young Lee 3, Hyun-Jung Kim 1, Jeong-Seon Ryu 4, Jun Hyeok Lim 5
    1Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea.
    2Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Inchon, Republic of Korea.
    3Department of Radiology, Inha University Hospital, Inha University College of Medicine, Inchon, Republic of Korea.
    4Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea. jsryu@inha.ac.kr.
    5Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea. jhl@inha.ac.kr.
    #Contributed equally.

  • 편집위원

    비소세포폐암 (NSCLC with EGFR, ALK, PD-L1 negative)의 뇌전이 환자에서 전뇌방사선치료의 임상적 장점이 명확치 않아 현재의 권고안에서 우선적으로 추천하지 않는 상황이다. 본 연구에서는 이러한 환자를 대상으로 전뇌방사선치료를 받은 환자군과 받지 않은 환자군으로 나누어 그 예후를 분석해본 바, 전뇌방사선치료를 받은 환자군에서 뇌내종양억제(iPFS) 효과와 함께 전체생존율 향상 효과가 있음을 보였고, 이에 따라 항암화학치료와 더불어 전뇌방사선치료가 고려되어야 한다고 밝혔다.

    2023-10-06 16:14:04

  • 편집위원2

    EGFR, ALK, PD-L1 negative이고 뇌전이를 동반한 비소세포폐암 환자에서 전뇌방사선치료를 항암화학요법 이전 혹은 항암화학요법과 동시에 시행한 환자의 두개내 무진행생존율 및 전체생존율이 전뇌방사선치료 없이 항암화학요법만을 받은 환자에 비해 더 높다는 분석

    2023-10-06 16:15:11

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