BACKGROUND Brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) are considered a major determinant of overall survival (OS). Historically, surgical resection (SR), stereotactic radiosurgery (SRS), or/and whole-brain radiation therapy (WBRT) followed by chemotherapy has been the treatment modalities for BM from lung adenocarcinoma. Recent insights into the biology of adenocarcinoma have led to a wealth of novel therapies, including tyrosine kinase inhibitors (TKIs). Here, we review the pattern of brain metastasis in lung adenocarcinoma patients and management strategies in our centre. MATERIAL AND METHODS We performed a single-centre retrospective analysis of patients with lung adenocarcinoma and BM between 2017–2020. Data were collected from electronic medical records, including clinical and histopathological features and outcomes. Survival curves were estimated with the Kaplan-Meier method and compared using the log-rank test. RESULTS We identified 29 patients, 65% male, median age 65 years (range 38–84); 55% ECOG PS 0–1; 59% smokers; 55% had extracranial metastases (ECM) and 66% were symptomatic, 24% were EGFR mutated, the frequency of ALK rearrangement was 14%, in 14% the molecular testing was not performed. We treated 59% with WBRT, 12% with SRS, 11% with SR+WBRT and 4% with SR+SRS; 14% were referred for palliative care. Clinical deterioration during local therapy was observed in 32% of the patients and, consequently, they haven’t undergone systemic treatment. After local treatment, 26% received chemotherapy (CT) and 28% received TKIs therapy. Median OS (mOS) was 11.3 months (95% CI 2.4–20.3) for the CT subgroup; mOS for the TKIs subgroup was not reached, but the 1-year survival rate was 67%. CONCLUSION BM confers a worse prognosis in lung adenocarcinoma patients. Currently, targeted systemic treatments in patients with driver mutations improve survival and have demonstrated efficacy in lung adenocarcinoma metastatic to the brain. Further research is needed to find better treatments for BM in NSCLC patients with no driver mutations.

中文翻译：

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P14.81 肺腺癌的脑转移 - 单中心的临床病理学特征和结果

背景技术 非小细胞肺癌 (NSCLC) 患者的脑转移 (BM) 被认为是总生存期 (OS) 的主要决定因素。从历史上看，手术切除 (SR)、立体定向放射外科 (SRS) 或/和全脑放射治疗 (WBRT) 继之以化疗一直是肺腺癌 BM 的治疗方式。最近对腺癌生物学的了解导致了大量的新疗法，包括酪氨酸激酶抑制剂 (TKI)。在这里，我们回顾了肺腺癌患者的脑转移模式和我们中心的管理策略。材料与方法 我们对 2017-2020 年间肺腺癌合并 BM 患者进行了单中心回顾性分析。数据来自电子病历，包括临床和组织病理学特征和结果。使用 Kaplan-Meier 方法估计生存曲线，并使用对数秩检验进行比较。结果 我们确定了 29 名患者，65% 为男性，中位年龄 65 岁（范围 38-84）；55% ECOG PS 0-1；59% 吸烟者；55% 有颅外转移（ECM），66% 有症状，24% 有 EGFR 突变，ALK 重排频率为 14%，14% 未进行分子检测。我们用 WBRT 治疗 59%，用 SRS 治疗 12%，用 SR+WBRT 治疗 11%，用 SR+SRS 治疗 4%；14% 被转诊接受姑息治疗。32% 的患者在局部治疗期间观察到临床恶化，因此，他们没有接受全身治疗。局部治疗后，26%接受化疗（CT），28%接受TKIs治疗。中位 OS (mOS) 为 11.3 个月 (95% CI 2.4–20. 3) 对于 CT 亚组；TKIs 亚组的 mOS 未达到，但 1 年生存率为 67%。结论 BM 对肺腺癌患者的预后较差。目前，对具有驱动突变的患者进行靶向全身治疗可提高生存率，并已证明对转移到大脑的肺腺癌有效。需要进一步的研究来为没有驱动突变的 NSCLC 患者找到更好的 BM 治疗方法。