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GAMMA KNIFE STEREOTACTIC RADIOSURGERY COMBINED WITH TARGETED THERAPY FOR BRAIN METASTASES IN NON-SMALL CELL LUNG CANCER WITH EGFR GENE MUTATIONS
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Abstract
Lung cancer is one of the most common malignancies and the leading cause of death from cancer in the world. In patients with NSCLC, patients with brain metastases have a higher rate of EGFR gene mutations than others, and the infrequency of brain metastasis of NSCLC with genetic mutations outperformed the group without mutations. In the past, brain metastasis was known to be a poor prognostic factor, but with the advancement of medicine, especially the introduction of targeted therapy and radiosurgery, outcomes have been significantly improved, including survival and symptom control. Our study aims to evaluate the outcome of Gamma Knife radiosurgery combined first-generation TKIs for brain metastasis of non-small cell lung cancer with EGFR or ALK gene mutations. Methods: We analyzed 44 patients with brain metastatic non-small cell lung cancer with EGFR gene mutations from July 2019 to June 2023. Selected patients have brain metastases from 1 to 10 tumors, size ≤ 3cm, KPS score ≥ 60, EGFR or ALK gene mutation, first-generation TKI treatment. Patients were treated by stereotactic radiosurgery using Leksell Gamma Knife ICON unit (Elekta AB) with dose of 20 – 24, 18 – 20Gy for lesions measuring < 2, 2.1 – 3 cm, respectively. Patients take 1st generation TKIs (erlotinib or gefitinib or crizotinib) 1 tablet per day. Patients were assessed for clinical symptoms and imaging response according to RANO criteria every 6 months and survival outcomes. Results: In our study, cerebral progression-free survival rate at 12 months was 94,8%, 24 months was 51,7%. Overall survival rate at 12 months was 83,9%, 24 months was 58,6%, 36months was 39,1%, overall survival time was 28 ± 3,3 months. Conclusion: Combination Gamma Knife radiosurgery with first-generation TKIs is an effective treatment for brain metastasis of non-small cell lung cancer with EGFR or ALK gene mutations.
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References
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