Abstract
Non-small cell lung cancer (NSCLC), a commonly diagnosed lung cancer, is characterized by a high incidence of metastatic spread to the brain, which adversely impacts prognosis. The present study aimed to assess the value of combined dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in predicting the treatment outcomes of whole-brain radiotherapy (WBRT) and gefitinib in brain metastases from non-small cell lung cancer (NSCLC) from the perspectives of response rate and short- and long-term efficacy. These results suggested that the indicators measured by DCE-MRI combined with DWI can be used as key imaging-derived markers that predicted the efficacy of WBRT combined with gefitinib in NSCLC patients with brain metastases. Specifically, patients with higher ΔADCmid and ΔADCpost values showed better treatment outcomes. ROC curve analysis indicated ADCpost, ΔADCpost, ΔADCpost (%), and tumor regression rate as the best predictors of efficacy of WBRT combined with gefitinib in these patients. The short-term and long-term effects noted were also significant. Taken together, the findings of this study reveal that tumor regression rate, ADCpost, ΔADCpost, and ΔADCpost (%) can be used as important imaging indicators that predict the therapeutic effect of WBRT combined with gefitinib in NSCLC patients with brain metastases.
Highlights
The prevalence and mortality of lung cancer are alarmingly high across the globe [1]
We could observe from conventional images and dynamic contrast-enhanced MRI (DCE-MRI) that all the 253 patients included in the study presented multiple brain metastases from Non-small cell lung cancer (NSCLC), with a total of about 5,153 widely distributed lesions, ranging 2–7 cm in diameter, most of which were in the supratentorial tentorium
Previous evidence has indicated that gefitinib in combination with radiotherapy brought about significant improvement of quality of life in a Chinese population with brain metastases from NSCLC [18]
Summary
The prevalence and mortality of lung cancer are alarmingly high across the globe [1]. Non-small cell lung cancer (NSCLC), accounting for about 80–85% of lung cancers, is commonly complicated by local and distal metastases, especially brain metastasis [2]. The high incidence of metastatic spread to the brain accounts for unsatisfactory prognosis of patients with NSCLC, and the median survival time of those untreated has been reported to be only about 1–3 months [3]. The currently utilized treatment strategies for brain metastasis from NSCLC include surgical treatment, radiotherapy, chemotherapy, targeted therapy, and immunotherapy [4]. Gefitinib is a first-generation tyrosine kinase inhibitor (TKI) for NSCLC [5,6]. Emerging evidence supports whole-brain radiation therapy (WBRT) and epidermal growth factor tyrosine kinase inhibitors (EGFRTKIs), such as gefitinib, erlotinib, and afatinib, for NSCLC patients affected by brain metastasis [7,8]
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