摘要目的：通过比较WBRT联合TKI与单纯TKI对EGFR突变NSCLC脑转移预后的影响，探讨靶向治疗同步联合WBRT的必要性。方法回顾分析2010—2014年间43例EGFR突变NSCLC脑转移病例，24例WBRT＋TKI，19例单纯TKI。结果全组24例WBRT＋TKI和19例单纯TKI的有效率分别为79％和37％（P＝0.002），6个月LC率分别为79％、63％（P＝0.008），中位 PFS期分别为23.7、8.3个月（ P＝0.025）。多因素分析显示原发灶控制、WBRT＋TKI、脑转移灶单发是PFS有利因素（ P＝0.033、0.019、0.019）。23例19外显子缺失患者中12例WBRT＋TKI、11例单纯TKI的有效率分别为100％、35％（ P＝0.000），6个月LC率分别为100％、55％（ P＝0.008），中位PFS期分别为23.7、8.4个月（ P＝0.003）。20例非19外显子缺失患者中12例WBRT＋TKI、8例TKI 的有效率分别为64％、50％（ P＝1.000），6个月LC率分别为58％、75％（ P＝0.642），中位PFS期分别为14.4、8.4个月（ P＝0.864）。结论 WBRT联合TKI治疗NSCLC脑转移优于单纯TKI，19外显子缺失患者可能获益更明显。

abstractsObjective To explore the necessity of EGFR?targeted therapy combined with synchronized whole brain radiotherapy ( WBRT ) for non?small?cell lung cancer ( NSCLC ) with mutated EGFR and brain metastasis by comparing the effects on prognosis between WBRT combined with tyrosine kinase inhibitor ( TKI) and TKI alone. Methods A retrospective analysis was performed in 43 patients with EGFR mutation?positive NSCLC and brain metastasis. In those patients, 24 patients received WBRT plus TKI and 19 patients TKI alone. Results The overall response rate ( RR) and 6?month intracranial disease control rate ( CR) were significantly higher in the WBRT+TKI group than in the TKI group ( 79% vs. 37%, P=0. 002;79% vs. 63%, P=0. 008). The median intracranial progression?free survival (IPFS) time was significantly longer in the WBRT+TKI group than in the TKI group ( 23. 7 vs. 8. 3 months, P=0. 025) . The multivariate analysis indicated that the control of lung cancer, WBRT+TKI, and single brain metastasis were favorable factors for substantially longer IPFS time ( P=0. 033,0. 019,0. 019) . In 23 patients with exon 19 deletion, 12 patients received WBRT+TKI and 11 patients TKI alone;compared with the TKI group, the WBRT+TKI group had significantly higher RR and 6?month CR as well as significantly longer IPFS ( 100%vs. 35%, P=0. 000;100% vs. 55%, P=0. 008;23. 7 vs. 8. 4 months, P=0. 003). In 20 patients without exon 19 deletion, however, there were no significant differences in RR or 6?month CR between the WBRT+TKI group (n=12) and the TKI group (n=8)(64% vs. 50%, P=1. 000;58% vs. 75%, P=0. 642).The median IPFS was 14. 4 and 8. 4 months ( P=0. 864) . Conclusions WBRT combined with TKI is superior to TKI alone in the treatment of NSCLC with brain metastasis. Patients with exon 19 deletion have substantially better treatment outcomes.