Purpose/Objective(s): Most NSCLC patients(pts.) with sensitizing EGFR mutations (L858R, Exon 19 deletion) have an impressive initial response, but most of the patients develop acquired resistance of TKI therapy after 9-14 months. More effective strategies to prevent resistance emergence are needed. For oligometastatic NSCLC patients with sensitive EGFR mutations, the role of local consolidative radiotherapy(LCR) remains debatable. The purpose of this study was to investigate the efficacy of LCR in oligometastatic NSCLC pts..
Materials/Methods: The records of pts. with initial stage IV NSCLC harboring EGFR mutation with oligometastasis in our Hospital were reviewed. Eligible pts. were treated with first-line EGFR-TKIs or EGFR-TKIs plus LCR (before progression). LCR regimens consist of stereotactic radiosurgery for all the brain oligometastasis and conventional fractional radiotherapy for extracranial metastasis. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier curves.
Results: From January 2013 to December 2016, a total of 98 pts. were enrolled, while 49 pts. received first-line EGFR-TKIs plus LCR (LCR group) and 49 pts. received first-line EGFR-TKIs only (non-LCR group). The baseline characteristics were well balanced between the two groups. For the whole cohort, median PFS in the LCR group (17 months) was significantly longer than that in the non-LCR group (10 months; p=.002), while median OS was also longer in the LCR group (38 vs. 29 months, p=.043). Among of 98 pts., 64 have undergone brain oligometastasis; the median PFS and OS were 17 months and 31 months, respectively, in the LCR group (n=35) compared to 10 months and 24 months, respectively, in the non-LCR group (n=29, p=0.035; p=0.019). For pts. with extracranial metastasis (n=34), the median PFS was 18 months vs. 10 months, favoring the first-line LCR group (n=14; p=.034); median OS was 43 months in the LCR group vs. 34 months in the non-LCR group (p=.338).
Conclusion: Our retrospective data suggest that first-line TKIs plus LCR is a promising therapeutic strategy that led to remarkable PFS improvement and survival benefits for pts. with oligometastatic EGFR-mutant NSCLC, particularly for pts. with brain oligometastasis. Hence, it should be considered as an important medical treatment during clinical management.
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