Whole Brain Radiation Therapy Plus Focal Radiation Boost May Generate Better Survival Benefit for Brain Metastases From Non-small Cell Lung Cancer.

Meng Ni,Wenju Liu,Yiqiang Qi,Shuanghu Yuan,Haiyan Zeng,Yong Wang,Jinming Yu,Yanxing Sheng,Aijun Jiang,Li Li,Yu Wang,Ning Liu

doi:10.3389/fonc.2020.576700

Abstract

BackgroundOwing to improved systemic therapies, the survival of patients with non-small cell lung cancer (NSCLC) was prolonged, and the risk of brain metastases was consequently increased. This study aims to compare different radiotherapy for brain metastases in patients with NSCLC.Materials and methodsThe patients with NSCLC who were treated with whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) for brain metastases at three medical centers between January 2012 and December 2017 were retrospectively analyzed.ResultsOf the 684 eligible patients, 217 received WBRT plus focal radiation boost (WBRT+boost), 324 received WBRT, and 143 received SRS. Patients with WBRT+boost lived longer than those with WBRT (median overall survival (OS), 22.2 vs 13.7 months, P < 0.001) or SRS (22.2 vs 17.3 months, P = 0.011). In subgroup analyses, the survival advantage of WBRT+boost was more obvious among patients with 1 to 3 brain metastases or who received targeted therapy than did SRS. From pair-wise comparisons of intracranial progression-free survival (iPFS), WBRT+boost was also superior to WBRT (12.9 vs 10.6 months, P = 0.028) and SRS (12.9 vs 9.1 months, P = 0.001).ConclusionsPatients who were treated with WBRT+boost experienced significantly longer OS and iPFS than those with WBRT or SRS alone. WBRT+boost should be a preferred strategy for brain metastases in NSCLC patients.

Highlights

Brain metastasis is the most common source of central nervous system tumors, and the majority of brain metastases originate from non-small cell lung cancer (NSCLC) [1, 2]
In the RTOG 9508 randomized clinical trial, Andrews et al found that compared to WBRT alone, WBRT plus SRS increased the OS in patients with single brain metastasis (6.5 vs 4.9 months, P = 0.039) [13]
Our data showed that for nonsmall cell lung cancer (NSCLC) patients who experienced brain metastases, WBRT+boost is associated with better OS and iPFS than WBRT or SRS alone

Summary

Introduction

Brain metastasis is the most common source of central nervous system tumors, and the majority of brain metastases originate from non-small cell lung cancer (NSCLC) [1, 2]. Since 1990s, the treatment of brain metastasis evolved localized therapies such as surgery, stereotactic radiosurgery (SRS), three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or combinations of the above treatments, together with systemic therapies, such as chemotherapy, molecular targeted therapy, and immunotherapy [6, 7]. With these treatments, median OS has been prolonged to more than 10 months [8, 9]. Owing to improved systemic therapies, the survival of patients with nonsmall cell lung cancer (NSCLC) was prolonged, and the risk of brain metastases was increased. This study aims to compare different radiotherapy for brain metastases in patients with NSCLC

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