Role of radiotherapy in treatment of non-operable EGFR-mutated NSCLC
Authors: M.A. Krasavina, A.V. Kirillov, I.R. Agranov, A.G. Ievleva, E.V. Artemieva, A.S. Zhabina, S.A. Belukhin, M.L. Makarkina, E.O. Elsakova, A.P. Oganesyan, V.A. Kheinstein, V.Yu. Khalturin, Ya.V. Belysheva, C.A. Guseinova, T.M. Sharabura, V.A. Chubenko, A.V. Myslik, N.V. Levchenko, A.A. Bogdanov, N.M. Volkov, V.V. Egorenkov, F.V. Moiseenko, V.M. Moiseenko
DOI: https://www.doi.org/10.31917/2504372
Background. Many clinical trials confirm the importance of local treatment integration in treatment of metastatic
cancer patients, including NSCLC. Local methods can be applied for oncologic emergencies treatment, as a consolidation
therapy, during progression, for patients with oligometastatic disease or with oligoprogression, and for CNS metastases
control. This real world data trial analyses survival depending of local treatments usage in EGFR-positive NSCLC.
Material and methods. This retrospective trial included 230 cases of EGFR-positive NSCLC treated in St. Petersburg Clinical
Research and Practical Center of Specialized Types for Medical Care (Oncological) named after N.P. Napalkov from 2022 to
2024. Two cohorts of patients were identified, with and without CNS involvement. Local treatment influence on survival was
analyzed in each group, as well as in resectable, oligometastatic and others groups of patients without brain metastases.
Results. Survival of 53 patients with CNS involvement and 108 patients without CNS involvement was analyzed. Local
treatment usage led to PFS and OS improvement almost in all cohorts and subgroups. Among patients with CNS metastases
median PFS was 11,47 month versus 15,60 months with local treatment (р=0,940). Median OS also favored local treatment
group: 18,47 months versus 32,47 months (р=0,119). Among patients without brain metastases median PFS was 19,63
months versus 15,87 months without local treamtment (р=0,378). Median OS was higher without local treatment – 56,0
versus 53,87 (р=0,322). Median PFS for resectable patients without brain metastases was 20,73 months versus 19,10 months
without local treatment (р=0,831), for oligometastatic cases 12,10 months versus 6,53 months (р=0,435) which also favored
local treatment group. For other patients PFS improvement after local treatment was also shown with median PFS 21,5
months versus 15,2 months (р=0,180).
Conclusion. Local treatment usage in patients with EGFR-mutated NSCLC numerically improves survival results. Small
number of patients demonstrates that treatment strategy for such patients must be regularly discussed by MDT. Also it is
important to mention notably high overall survival in analyzed cohort in general. As the results are statistically insignificant,
careful selection of patients with favorable prognosis for local treatment strategies requires further research.