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Is it advisable to perform radiosurgery for EGFR-TKI-controlled brain metastases? A retrospective study of the role of radiosurgery in lung cancer treatment

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Abstract

Purpose

Given the availability of TKIs with high central nervous system efficacy, the question arises as to whether upfront SRS provides additional clinical benefits. The goal of this study was to characterize the clinical outcomes of SRS as salvage therapy for TKI-uncontrolled BMs.

Methods

This retrospective study included EGFR-mutant NSCLC patients presenting BMs at the time of primary tumor diagnosis. BMs were categorized into three subgroups, referred to as “Nature of TKI-treated BMs”, “TKI-controlled brain metastases ± SRS”, and “SRS salvage therapy”. The first subgroup analysis characterized the effects of TKIs on tumor behavior. In the second subgroup, we compared outcomes of TKI-controlled BMs treated with TKI alone versus those treated with combined TKI-SRS therapy. The third subgroup characterized the outcomes of TKI-uncontrolled BMs treated with SRS as salvage therapy Clinical outcomes include local and distant tumor control.

Results

This study included 106 patients with a total of 683 BMs. TKI treatment achieved control in 63% of local tumors at 24 months. Among the TKI-controlled BMs, local tumor control was significantly higher in the combined TKI-SRS group (93%) than in the TKI-alone group (65%) at 24 months (p < 0.001). No differences were observed between the two groups in terms of distant tumor control (p = 0.832). In dealing with TKI-uncontrolled BMs, salvage SRS achieved local tumor control in 58% of BMs at 24 months.

Conclusions

While upfront TKI alone proved highly effective in BM control, this study also demonstrated the outcomes of SRS when implemented concurrently with TKI or as salvage therapy for TKI-uncontrolled BMs. This study also presents a strategy of the precise timing and targeting of SRS to lesions in progression.

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Abbreviations

BM:

Brain metastasis

EGFR:

Epidermal growth factor receptor

GKRS:

Gamma-knife radiosurgery

KPS:

Karnofsky Performance Scale

MRI:

Magnetic resonance imaging

NSCLC:

Non-small cell lung cancer

SRS:

Stereotactic radiosurgery

TKI:

Tyrosine kinase inhibitor

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Joseph Shang-En Hung, Yan-Hua Su, Huai-Che Yang, Kang-Du Liu, Wen-Yuh Chung & Cheng-Chia Lee

  2. Department of Neurological Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Ching-Jen Chen

  3. Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chi-Lu Chiang, Chia-I Shen & Yung-Hung Luo

  4. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chi-Lu Chiang, Chia-I Shen, Huai-Che Yang, Yung-Hung Luo, Hsiu-Mei Wu, Yong-Sin Hu, Chung-Jung Lin, Kang-Du Liu, Wen-Yuh Chung, Wan-Yuo Guo & Cheng-Chia Lee

  5. Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chi-Lu Chiang, Chia-I Shen, Cheng-Ying Shiau & Yung-Hung Luo

  6. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Ying Shiau

  7. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsiu-Mei Wu, Yong-Sin Hu, Chung-Jung Lin & Wan-Yuo Guo

  8. Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Cheng-Chia Lee

  9. Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Wen-Yuh Chung

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  1. Joseph Shang-En Hung
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Contributions

The first draft of the manuscript was written by Joseph Shang-En Hung and all authors commented on previous versions of the manuscript. All authors reviewed and approved the manuscript.

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Correspondence to Cheng-Chia Lee.

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Hung, J.SE., Su, YH., Chen, CJ. et al. Is it advisable to perform radiosurgery for EGFR-TKI-controlled brain metastases? A retrospective study of the role of radiosurgery in lung cancer treatment. J Neurooncol 164, 413–422 (2023). https://doi.org/10.1007/s11060-023-04425-0

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