Abstract：
OBJECTIVE: Tyrosine kinase inhibitors (TKIs) is the first-line treatment for EGFR-positive non-small cell lung cancer (NSCLC); however, its applicability to patients with wild-type NSCLC remains an issue of contention. This study compared the effects of gamma knife radiosurgery (GKRS) alone versus combining GKRS and TKIs in treating two genetic forms of NSCLC.
METHODS: This retrospective study examined 479 NSCLC patients with 1982 brain metastases who underwent GKRS and for whom imaging follow-up data or death records were available. All our patients were consecutive. All gene mutations were confirmed by lung biopsy. The three main endpoints in this study were overall survival (OS), local intracranial tumor control (LC), and distal intracranial tumor control (DC).
RESULTS: There were 296 NSCLC patients with EGFR positive: TKI treatment (n = 262) and without TKI treatment (n = 34). GKRS + TKIs was more effective than GKRS alone in terms of OS (HR 0.53, p = 0.085) and DC (HR 0.51, p < 0.001). There were 150 NSCLC patients with wild-type EGFR: TKI treatment (n = 50) and without TKI treatment (n = 100). GKRS + TKIs was less effective than GKRS alone in terms of OS (HR 1.82, p = 0.049) and DC (HR: 1.40, p = 0.011). We observed no difference in terms of LC in both genetic groups.
CONCLUSIONS: Combining GKRS with TKIs proved effective in EGFR positive NSCLC patients; however, we do not observe the similar results when combining GKRS with TKIs for patients with wild-type NSCLC.
METHODS: This retrospective study examined 479 NSCLC patients with 1982 brain metastases who underwent GKRS and for whom imaging follow-up data or death records were available. All our patients were consecutive. All gene mutations were confirmed by lung biopsy. The three main endpoints in this study were overall survival (OS), local intracranial tumor control (LC), and distal intracranial tumor control (DC).
RESULTS: There were 296 NSCLC patients with EGFR positive: TKI treatment (n = 262) and without TKI treatment (n = 34). GKRS + TKIs was more effective than GKRS alone in terms of OS (HR 0.53, p = 0.085) and DC (HR 0.51, p < 0.001). There were 150 NSCLC patients with wild-type EGFR: TKI treatment (n = 50) and without TKI treatment (n = 100). GKRS + TKIs was less effective than GKRS alone in terms of OS (HR 1.82, p = 0.049) and DC (HR: 1.40, p = 0.011). We observed no difference in terms of LC in both genetic groups.
CONCLUSIONS: Combining GKRS with TKIs proved effective in EGFR positive NSCLC patients; however, we do not observe the similar results when combining GKRS with TKIs for patients with wild-type NSCLC.
摘要：
目的：酪氨酸激酶抑制剂(TKIs)是EGFR阳性非小细胞肺癌(NSCLC)的一线治疗药物；其对野生型NSCLC患者的适用性仍是一个有争议的问题.这项研究比较了单独伽玛刀放射外科（GKRS）与GKRS和TKIs联合治疗两种遗传形式的NSCLC的效果。
方法：这项回顾性研究检查了479例1982年脑转移NSCLC患者，这些患者接受了GKRS治疗，并获得了影像学随访数据或死亡记录。我们所有的病人都是连续的。所有基因突变均通过肺活检证实。这项研究的三个主要终点是总生存期(OS)，局部颅内肿瘤控制（LC），和远端颅内肿瘤控制（DC）。
结果：有296例EGFR阳性的NSCLC患者：TKI治疗（n=262）和无TKI治疗（n=34）。就OS(HR0.53,p=0.085)和DC(HR0.51,p<0.001)而言,GKRS+TKI比单独GKRS更有效。有150例接受野生型EGFR：TKI治疗（n=50）和未接受TKI治疗（n=100）的NSCLC患者。就OS(HR1.82,p=0.049)和DC(HR:1.40,p=0.011)而言,GKRS+TKIs的效果不如单独GKRS有效。我们在两个遗传组中观察到LC没有差异。
结论：在EGFR阳性NSCLC患者中，GKRS与TKIs联合被证明是有效的；然而，对于野生型NSCLC患者,我们没有观察到GKRS与TKIs联合治疗的类似结果.
方法：这项回顾性研究检查了479例1982年脑转移NSCLC患者，这些患者接受了GKRS治疗，并获得了影像学随访数据或死亡记录。我们所有的病人都是连续的。所有基因突变均通过肺活检证实。这项研究的三个主要终点是总生存期(OS)，局部颅内肿瘤控制（LC），和远端颅内肿瘤控制（DC）。
结果：有296例EGFR阳性的NSCLC患者：TKI治疗（n=262）和无TKI治疗（n=34）。就OS(HR0.53,p=0.085)和DC(HR0.51,p<0.001)而言,GKRS+TKI比单独GKRS更有效。有150例接受野生型EGFR：TKI治疗（n=50）和未接受TKI治疗（n=100）的NSCLC患者。就OS(HR1.82,p=0.049)和DC(HR:1.40,p=0.011)而言,GKRS+TKIs的效果不如单独GKRS有效。我们在两个遗传组中观察到LC没有差异。
结论：在EGFR阳性NSCLC患者中，GKRS与TKIs联合被证明是有效的；然而，对于野生型NSCLC患者,我们没有观察到GKRS与TKIs联合治疗的类似结果.
