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Prognostic value of cranial radiotherapy and optimal timing stratified by lung-molGPA for NSCLC patients with brain metastases

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Abstract

Purpose

The updated Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (lung-molGPA) index provide more accurate survival prediction for patients diagnose with advanced non-small cell lung cancer (NSCLC) with brain metastases (BM). Given that the value of cranial radiotherapy (CRT) is still controversial for NSCLC patients with BM, this retrospective study aimed to evaluate the value of CRT and optimal timing in NSCLC patients with initial BM after stratified with lung-molGPA index.

Methods

This study screened NSCLC patients with initial BM in our cancer center from February 2012 to July 2018. The prognosis value of CRT and optimal timing was evaluated with Kaplan–Meier survival analysis and the patients were classified into lung-molGPA0–2 and lung-molGPA2.5–4 group. Upfront CRT was defined as received CRT within 3 months after initial diagnosis and without BM progression, other CRT was classified into deferred CRT.

Results

Overall, 288 patients were enrolled in our study, 156 patients received CRT. The median follow-up time was 47 months. In the entire cohort, the median PFS and OS were 9.2 and 17.0 months, respectively. In the lung-molGPA2.5–4 group, CRT can bring significantly overall survival benefit for NSCLC patients with initial BM (HR: 0.48, 95% CI: 0.34–0.68, P < 0.0001), and the upfront CRT can further expand this survival benefits compared with deferred CRT (HR: 0.49, 95% CI: 0.27–0.89, P = 0.0026). But this phenomenon was not observed in lung-molGPA0–2 group patients.

Conclusion

Upfront CRT could bring significantly overall survival benefit for these patients with lung-molGPA2.5–4 but not for patients with lung-molGPA0–2.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Natural Science Foundation of China [Grant Number: 81972862 and 82030082]; CSCOPilot Cancer Research Fund [Grant Number: Y-2019AZZD-0352] and Shandong Province Natural Science Foundation innovation and development joint fund project [Grant Number: ZR2022LZL008].

Author information

Author notes

  1. Wenxiao Jia and Xiaoyang Zhai contributed equally to this work.

Authors and Affiliations

  1. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 109 Machang Road, Wuhan, 430022, Hubei, China

    Wenxiao Jia & Gang Wu

  2. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China

    Wenxiao Jia, Xiaoyang Zhai, Xuquan Jing, Shuhui Xu, Hui Zhu & Jinming Yu

  3. The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China

    Xiaoyang Zhai

  4. Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China

    Xuquan Jing

  5. Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, 250021, Shandong, China

    Qingdong Bao

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  1. Wenxiao Jia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Wenxiao Jia, Xiaoyang Zhai, Xuquan Jing and Qingdong Bao. The first draft of the manuscript was written by Wenxiao Jia, Xiaoyang Zhai and Shuhui Xu. Project administration, formal analysis and conceptualization was complete by Jinming Yu, Hui Zhu and Gang Wu. And all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hui Zhu, Gang Wu or Jinming Yu.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This is a retrospectively observational study. The Shandong Cancer Hospital and Institute Ethics Committee has confirmed that no ethical approval is required.

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Informed consent was obtained from all individual participants included in the study.

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Jia, W., Zhai, X., Jing, X. et al. Prognostic value of cranial radiotherapy and optimal timing stratified by lung-molGPA for NSCLC patients with brain metastases. J Neurooncol 164, 321–330 (2023). https://doi.org/10.1007/s11060-023-04426-z

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