<p>Survival and intracranial control outcomes of whole-brain radiotherapy (WBRT) alone versus WBRT plus a radiotherapy boost in non-small-cell lung cancer with brain metastases: a single-institution retrospective analysis</p>

Abstract

Purpose: To compare the differences in survival and intracranial local control between patients treated with whole-brain radiotherapy (WBRT) and WBRT plus a radiotherapy boost (RTB) in non-small-cell lung cancer (NSCLC) patients with brain metastases (BMs). Patients and methods: Between May 2010 and October 2017, 206 NSCLC patients with BMs were treated with brain radiotherapy; among these patients, 140 patients underwent WBRT alone (group A) and 66 patients underwent WBRT plus RTB (group B). The endpoints included intracranial local progression-free survival and regional progression-free survival time (iLPFS and iRPFS, respectively) and overall survival (OS). Results: Between the two groups, not all baseline clinical factors were well-balanced. The median iLPFS was 17.9 months in group A and 22.3 months in group B. The 2-year iLPFS rates were significantly lower in group A than in group B (34.5% vs 49.3%, P =0.041); however, no significant differences were observed in OS or iRPFS. Multivariate analyses revealed that epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) therapy was significantly associated with good OS, iLPFS, and iRPFS. Among the patients treated with TKIs (n=62), there were no differences in OS ( P =0.190), iLPFS ( P =0.334), or iRPFS ( P =0.338) between groups A and B. In the patients without TKI treatment (n=102), the median iLPFS was significantly longer in group B than in group A (16.7 vs 12.0 months, P =0.032), but no significant differences were found in OS ( p =0.182) or iRPFS ( P =0.837) between the two groups. Conclusion: WBRT plus RTB significantly improved iLPFS compared with WBRT alone, especially in patients without EGFR-TKI treatment. However,there were no significant differences in iRPFS or OS between the two groups. Patients treated with EGFR-TKIs may not benefit from WBRT plus RTB.

Whole-Brain Radiation Therapy With Simultaneous Integrated Boost Versus Whole-Brain Radiation Therapy Plus Stereotactic Radiosurgery for the Treatment of Brain Metastasis From Lung Cancer

“…Therefore, the difference in baseline situations may be the cause of the longer intracranial PFS in our study. Lu (20) compared the efficacy of WBRT + SIB with that of WBRT; the median intracranial PFS in the WBRT + SIB group was 22.3 months, which was higher than that observed in our study. However, in the study by Lu, the radiation dose of WBRT was higher than that used in our study.…”

“…A dosimetric study showed that WBRT combined with SIB (WBRT + SIB) could satisfy the target dose and protect the surrounding normal tissues such as the hippocampus (19). Several studies have also reported that WBRT + SIB significantly improves ICR and survival compared to WBRT alone (14,16,20). However, it is unclear whether WBRT + SIB can improve efficacy and reduce toxicity compared to WBRT + SRS.…”

Analysis of the efficacy and prognostic factors of linear accelerator-based hypofractionated stereotactic radiotherapy for brain metastasis of non-small-cell lung cancer

“…Our study suggested that non-adenocarcinoma is an independent adverse prognostic factor affecting OS, iLPFS, and iRPFS (P < 0.05), consistent with previous studies. GPA and RPA can predict the survival of patients with BMs (25)(26)(27). In our study, the single-factor analysis suggested that GPA had some effect on OS and iRPFS (P < 0.1), and RPA had some effect on OS, iLPFS and iRPFS (P < 0.05).…”

“…Fifty-one patients (63.8%) received a dose of 30 Gy/3 f PTV. Five patients (6.2%) received a radiotherapy dose less than PTV 30 Gy/3 f and a median dose of 20.6 Gy/3 f in the PTV range of [14][15][16][17][18][19][20][21][22][23][24][25][26][27] Gy/2-3 f. Twenty-four patients (30.0%) received radiotherapy doses greater than PTV 30 Gy/3 f, and PTV median dose of 36.4 Gy/5 f, with a range of PTV 34-45 Gy/3-9 f. For radiotherapy techniques, 37 patients (46.3%) received TOMO, and 43 patients (53.7%) received VMAT.…”

Time taken for a primary tumor to metastasize to the brain and the overall survival of patients with brain metastasis: An analysis of outcomes and factors affecting survival

“…Nevertheless, the adverse effects of RT cannot be ignored. In fact, many studies have described the adverse effects of RT, such as radionecrosis [19][20][21], which is difficult to diagnose and treat.…”