Treatment and prognostic analysis of non-small cell lung cancer with leptomeningeal metastases

WANG Dongsheng; PAN Wei; YANG Yan; MA Ying; YANG Xiuting

doi:10.3969/j.issn.1009-0460.2018.03.009

Abstract：Objective To analyze the treatment and prognosis of non-small cell lung cancer (NSCLC) with leptomeningeal metastases. Methods A retrospective analysis of 95 NSCLC patients with leptomeningeal metastases from May 2012 to October 2015 was reviewed. Patients received intravenous chemotherapy, whole brain radiation, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) or optimal support according to the baseline. The survival rate was calculated by Kaplan-Meier method and the single factor prognosis was analyzed with Log-rank method. The prognosis related multiple factor was analyzed by Cox proportional risk regression model. Results The median overall survival (OS) of the 95 patients was 6.4 months, and the 1-year survival rate was 6.3％. The median OS of 57 patients receiving whole brain radiation therapy was 8. 4 months, superior to 4.0 months of 38 patients who did not receive whole brain radiation (P＜0.001). The median OS of 40 patients receiving intravenous chemotherapy was 5.4 months, less than 7.5 months in 55 cases without chemotherapy (P = 0.010). The median OS of 49 patients receiving EGFR-TKIs treatment was 7.4 months, superior to 5.0 months in 46 patients who had not received EGFR-TKIs treatment. In addition, the longest median OS (9.4 months) was observed in 22 patients receiving whole brain radiation combined with EGFR-TKIs. ECOG score, whole brain radiation therapy and EGFR-TKIs were independent prognostic factors for NSCLC with leptomeningeal metastases. Conclusion Whole brain radiation therapy, EGFR-TKIs, especially combined therapy, could lead to better clinical prognosis for NSCLC patients with leptomeningeal metastases. EGFR-TKIs combined with whole brain radiotherapy are the most promising treatment plan.