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不同预后评分下非小细胞肺癌脑转移患者补量放疗的预后分析
申东星,刘志坤,李振生,韩慧娜,尚宇光,朱龙玉,孔德友,张安度,孔洁,张舰杨芳,曲福印,张钧
河北医科大学第四医院东院放疗科,石家庄 050035
Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with supplemental radiotherapy under different prognostic scores
Shen Dongxing, Liu Zhikun, Li Zhensheng, Han Huina, Shang Yuguang, Zhu Longyu, Kong Deyou, Zhang Andu, Kong Jie, Zhang Jian, Yang Fang, Qu Fuyin, Zhang Jun
Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050035, China
Abstract：Objective To analyze the prognosis and influencing factors of different radiotherapy modes in patients with brain metastases from non-small cell lung cancer (NSCLC), and to explore the best benefit population with radiotherapy boost under different prognostic scores. Methods 634 patients with brain metastasis from NSCLC admitted to the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively. According to different radiotherapy modes, they were divided into three groups:no radiotherapy group (n=330), whole-brain radiotherapy group (WBRT)(n=127) and whole-brain radiotherapy combined with boost group (WBRT+boost)(n=177). The intracranial progression-free survival (iPFS) and overall survival (OS) were calculated by Kaplan-Meier method. The multivariate prognostic factors were analyzed by the Cox models. Results The median iPFS and OS of all patients were 6.9 months and 9.0 months, respectively. In the no radiotherapy, WBRT and WBRT+boost groups, the 1-year iPFS was 15.1%, 16.3% and 40.2%(P=0.002), and the 1-year OS was 33.7%, 38.2% and 48.1%(P<0.001), respectively. Multivariate survival analysis demonstrated that different radiotherapy modes were the independent factors affecting iPFS and OS. Subgroup analysis revealed that for patients with 1-3 brain metastases, the 1-year OS and iPFS in the WBRT+boost group were better than those of WBRT alone (P=0.026, P=0.044) when GPA score was 2.5-4.0;the 1-year OS and iPFSin the WBRT+boost group were better than those of WBRT alone (P=0.036, P=0.049) when there was no targeted therapy;for patients with ≥4 brain metastases, the 1-year iPFS in the WBRT+boost group was better than that of WBRT alone (P=0.019, P=0.012) when GPA score was 2.5-4.0 and there was no targeted therapy. When the GPA score was 0-2 or there was targeted therapy, the 1-year OS and iPFS in the WBRT+boost group were better than those of WBRT alone, but the difference was not statistically significant (all P>0.05). Conclusions Radiotherapy can significantly improve the iPFS and OS of NSCLC patients with brain metastases. When the number of brain metastases is 1-3, GPA score is 2.5-4.0 or no targeted therapy, boost may improve the iPFS and OS;when the number of brain metastases is more than 4, GPA score is 2.5-4.0 or no targeted therapy, boost may only bring iPFS benefit;when GPA score is 0-2 or targeted therapy, boost may not benefit significantly.
. Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with supplemental radiotherapy under different prognostic scores[J]. Chinese Journal of Radiation Oncology, 2022, 31(2): 131-137.
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