The Influence of Biomarker Mutations and Systemic Treatment on Cerebral Metastases from NSCLC Treated with Radiosurgery

Lee, Min Ho; Kong, Doo-Sik; Seol, Ho Jun; Nam, Do-Hyun; Lee, Jung-Il

추천

검색

자료유형: 학술저널

저자정보: Lee, Min Ho (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Kong, Doo-Sik (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Seol, Ho Jun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Nam, Do-Hyun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Lee, Jung-Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제60권 제1호

발행연도: 2017.1

수록면: 21 - 29 (9page)

이용수

📌

연구주제

📖

연구배경

🔬

연구방법

🏆

연구결과

초록· 키워드

오류제보하기

Objective : The purpose of this study was to analyze outcomes and identify prognostic factors in patients with cerebral metastases from non-small cell lung cancer (NSCLC) treated with gamma knife radiosurgery (GKS) particularly, focusing on associations of biomarkers and systemic treatments. Methods : We retrospectively reviewed the medical records of 134 patients who underwent GKS for brain metastases due to NSCLC between January 2002 and December 2012. Representative biomarkers including epidermal growth factor receptor (EGFR) mutation, K-ras mutation, and anaplastic lymphoma kinase (ALK) mutation status were investigated. Results : The median overall survival after GKS was 22.0 months (95% confidence interval [CI], 8.8-35.1 months). During follow-up, 63 patients underwent salvage treatment after GKS. The median salvage treatment-free survival was 7.9 months (95% CI, 5.2-10.6 months). Multivariate analysis revealed that lower recursive partition analysis (RPA) class, small number of brain lesions, EGFR mutation (+), and ALK mutation (+) were independent positive prognostic factors associated with longer overall survival. Patients who received target agents 30 days after GKS experienced significant improvements in overall survival and salvage treatment-free survival than patients who never received target agents and patients who received target agents before GKS or within 30 days (median overall survival: 5.0 months vs. 18.2 months, and 48.0 months with p-value=0.026; median salvage treatment-free survival: 4.3 months vs. 6.1 months and 16.6 months with p-value=0.006, respectively). To assess the influence of target agents on the pattern of progression, cases that showed local recurrence and new lesion formation were analyzed according to target agents, but no significant effects were identified. Conclusion : The prognosis of patients with brain metastases of NSCLC after GKS significantly differed according to specific biomarkers (EGFR and ALK mutations). Our results show that target agents combined with GKS was related to significantly longer overall survival, and salvage treatment-free survival. However, target agents were not specifically associated with improved local control of the lesion treated by GKS either development of new lesions. Therefore, it seems that currently popular target agents do not affect brain lesions themselves, and can prolong survival by controlling systemic disease status.

#Non-small cell lung cancer #EGFR #K-ras #ALK #Gamma knife radiosurgery

참고문헌 (42)

참고문헌 신청

Ahn HK / 2013 / Successful treatment with crizotinib in mechanically ventilated patients with ALK positive non-small-cell lung cancer / J Thorac Oncol 8:250~253

Alexander E 3rd / 1995 / Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases / J Natl Cancer Inst 87:34~40

Andrews DW / 2004 / Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases:phase III results of the RTOG 9508 randomised trial / Lancet 363:1665~1672

Baschnagel AM / 2013 / Tumor volume as a predictor of survival and local control in patients with brain metastases treated with gamma knife surgery / J Neurosurg 119:1139~1144

Bhatnagar AK / 2006 / Stereotactic radiosurgery for four or more intracranial metastases / Int J Radiat Oncol Biol Phys 64:898~903

함께 읽어보면 좋을 논문

논문 유사도에 따라 DBpia 가 추천하는 논문입니다. 함께 보면 좋을 연관 논문을 확인해보세요!