Prediction of treatment effect of whole brain radiation therapy by plasma free DNA focused on genomic mutations

2023 Fiscal Year Final Research Report

• Project/Area Number: 21K15816
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 52040:Radiological sciences-related
• Research Institution: Dokkyo Medical University
• Principal Investigator: Hirano Yasuhiro 獨協医科大学, 医学部, 講師 (50593191)
• Project Period (FY): 2021-04-01 – 2024-03-31
• Keywords: 全脳照射 / 髄膜播種

Outline of Final Research Achievements

We studied the cases of whole-brain radiotherapy (WBRT) for leptomeningeal metastasis (LM) with lung adenocarcinoma. We retrospectively evaluated overall survival (OS) after WBRT and clinical variables, including EGFR/ALK status, in 80 consecutive patients who received WBRT for LM from lung adenocarcinoma at our institution between June 2013 and June 2021. We analyzed the following variables at the start of WBRT as the factors associated with OS and intracranial PFS: age, sex, Eastern Cooperative Oncology Group (ECOG) performance status (PS), EGFR/ALK status, presence of brain metastasis, presence of hydrocephalus, presence of extracranial metastasis, primary tumor control, and the number of systemic chemotherapy regimens (including central nervous system-penetrant EGFR and ALK tyrosine kinase inhibitors or immune checkpoint inhibitors) before WBRT. Multivariate analysis indicated that EGFR/ALK alterations and ECOG PS 0-1 were independent factors for favorable OS after WBRT.

Free Research Field

放射線治療

Academic Significance and Societal Importance of the Research Achievements

肺癌中枢神経系転移は20～40%と高頻度であり、予後を決定する一因である。様々な背景因子が含まれ、放射線治療への反応性や予後が異なるが、全身状態や頭蓋外転移の有無などの既存の因子では全脳照射の効果予測は十分でない。
国立がん研究センター東病院で2013年6月から2021年6月までに肺腺癌の髄膜播種に全脳照射を施行した80症例の予後についての後方視的検討により、髄膜播種に対する全脳照射後の予後は不良であるが、パフォーマンスステータスが0-1、EGFR変異陽性またはALK転座陽性の患者において長期予後との関連が認められた。