Background: The treatment strategy for brain metastasis (BM) in patients with epidermal growth factor receptor\n(EGFR) -mutant lung adenocarcinoma (LAC) remains controversial. In the present study, we compared the efficacy\nof brain radiotherapy (RT) in combination with tyrosine kinase inhibitors (TKIs) and TKIs alone for advanced LAC\npatients with EGFR mutations and BM.\nMethods: We retrospectively studied 78 patients diagnosed with EGFR-mutant LAC who developed BM. These\npatients were divided into two groups: 49 patients in the combination treatment group who received brain RT in\ncombination with EGFR-TKIs (including 23 patients with asymptomatic BM before RT); 29 patients in the TKI group\nwho received EGFR-TKI targeted therapy alone (including 22 patients with asymptomatic BM before TKI treatment).\nResults: The median intracranial progression-free survival (iPFS) of the combination treatment group was longer\nthan that of the TKI alone group (21.5 vs. 15 months; P = 0.036). However, there were no significant differences in\nmedian progression-free survival (PFS, 12 vs. 13 months; P = 0.242) and median overall survival (mOS, 36 vs. 23\nmonths; P = 0.363) between the two groups. Further analysis of asymptomatic BM showed that both the median\niPFS and the mOS of the combination treatment group were significantly longer than for the TKI alone group (iPFS,\n21.5 vs. 14.8 months, P = 0.026; mOS, 36 vs. 23 months, P = 0.041). Cox multivariate regression analysis found no\nindependent adverse predictors of iPFS in all patients.\nConclusions: The synchronous combination of brain RT and TKIs was superior to EGFR-TKIs alone for EGFR-mutant\nLAC patients with BM. The combination treatment group exhibited longer iPFS, while the PFS and OS were not\nsignificantly different between the two groups. In addition, the combination treatment could result in better iPFS and\nOS in those with asymptomatic BM. Therefore, addition of brain RT was useful for intracranial metastatic lesions.
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