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<p>We evaluated the efficacy of intervention timing of craniocerebral radiotherapy (RT) combined with third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) on prognosis of patients with EGFR mutant lung adenocarcinoma complicated with brain metastasis. In total, 348 patients with advanced non-small cell lung cancer (NSCLC) harboring EGFR mutations were enrolled in this retrospective study between March 2008 and September 2023. Propensity score matching (PSM) was used to adjust for demographic and clinical variables and compare survival between the EGFR-TKI plus craniocerebral RT group and the EGFR-TKI only group. Patients were categorized into upfront and delayed groups based on the timing of craniocerebral RT. Lung molGPA, overall survival (OS), and intracranial progression-free survival (iPFS) were calculated. Kaplan–Meier analysis compared iPFS and OS across groups. The 348 patients enrolled who used the third generation of EGFR-TKIs during the treatment. The median OS was 61.2&#xa0;months, while the median iPFS was 15.0&#xa0;months before PSM. After PSM, the median OS of EGFR-TKIs + craniocerebral radiotherapy group and EGFR-TKI alone group was 67.7&#xa0;months and 48.4&#xa0;months respectively (<i>p</i> = 0.0155). Of 206 patients who underwent craniocerebral RT, were enrolled subsequently and divided into upfront-group and delay-group showed that the median OS was 72.0 and 67.7&#xa0;months respectively (<i>p</i> = 0.2841). For group A, the median OS of upfront-group and delay-group was 27.9 and 45.3&#xa0;months, respectively (<i>p</i> = 0.0124). For patients in group B, there was significant difference in OS between the two groups (<i>p</i> = 0.0478). The median OS of the two groups was 97.7 and 70.5&#xa0;months, respectively. Combining third-generation EGFR-TKIs with craniocerebral RT confers enhanced survival benefits for patients with craniocerebral metastases of EGFR-mutant lung adenocarcinoma. Upfront craniocerebral RT is recommended for patients with high lung-molGPA scores to improve both iPFS and OS.</p>

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Survival outcomes of upfront versus delayed craniocerebral radiotherapy in EGFR-mutant NSCLC patients treated with third-generation EGFR-TKIs

  • 期刊论文

  • 发表日期：

    2025年9月6日

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  • Guangchuan Deng,
  • Yuanliang Zhou,
  • Zhimin Wang,
  • Jing Fan,
  • Chenran Zhao,
  • Jianbin Li,
  • Zhenxiang Li

摘要

We evaluated the efficacy of intervention timing of craniocerebral radiotherapy (RT) combined with third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) on prognosis of patients with EGFR mutant lung adenocarcinoma complicated with brain metastasis. In total, 348 patients with advanced non-small cell lung cancer (NSCLC) harboring EGFR mutations were enrolled in this retrospective study between March 2008 and September 2023. Propensity score matching (PSM) was used to adjust for demographic and clinical variables and compare survival between the EGFR-TKI plus craniocerebral RT group and the EGFR-TKI only group. Patients were categorized into upfront and delayed groups based on the timing of craniocerebral RT. Lung molGPA, overall survival (OS), and intracranial progression-free survival (iPFS) were calculated. Kaplan–Meier analysis compared iPFS and OS across groups. The 348 patients enrolled who used the third generation of EGFR-TKIs during the treatment. The median OS was 61.2 months, while the median iPFS was 15.0 months before PSM. After PSM, the median OS of EGFR-TKIs + craniocerebral radiotherapy group and EGFR-TKI alone group was 67.7 months and 48.4 months respectively (p = 0.0155). Of 206 patients who underwent craniocerebral RT, were enrolled subsequently and divided into upfront-group and delay-group showed that the median OS was 72.0 and 67.7 months respectively (p = 0.2841). For group A, the median OS of upfront-group and delay-group was 27.9 and 45.3 months, respectively (p = 0.0124). For patients in group B, there was significant difference in OS between the two groups (p = 0.0478). The median OS of the two groups was 97.7 and 70.5 months, respectively. Combining third-generation EGFR-TKIs with craniocerebral RT confers enhanced survival benefits for patients with craniocerebral metastases of EGFR-mutant lung adenocarcinoma. Upfront craniocerebral RT is recommended for patients with high lung-molGPA scores to improve both iPFS and OS.