BACKGROUND AND PURPOSE To analyze outcomes of non-small cell lung cancer (NSCLC) patients with brain metastases harboring EGFR or ALK mutations and examine for differences between tyrosine kinase inhibitors (TKIs) alone, radiotherapy (RT) alone (either whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS)), or combined TKIs and RT. MATERIALS AND METHODS Thirty studies were identified. PATIENTS with brain metastases from NSCLC. INTERVENTION initial TKIs alone with optional salvage RT, RT alone, or TKIs and RT. CONTROL wild-type NSCLC and TKIs alone for mutational and treatment analysis, respectively. OUTCOMES overall survival (OS) and intracranial progression-free survival (PFS). SETTING studies with mutation information. RESULTS A total of 2649 patients were included. Patients with ALK and EGFR mutations had significantly higher median OS (48.5 months, p < 0.0001; and 20.9 months; p = 0.0006, respectively) compared to wild-type patients (9.9 months). Similar median OS was noted between TKIs and RT (28.3 months), RT alone (32.2 months; p = 0.22), or TKIs alone (23.9 months; p = 0.2). Patients treated with TKIs and RT had higher median PFS (18.6 months; p = 0.06) compared to TKIs alone (13.6 months) with no difference between TKIs and RT vs. RT alone (16.9 months; p = 0.72). No PFS difference was found between WBRT and TKI (23.2 months; p = 0.72) vs. WBRT alone (24 months) or SRS and TKI (16.7 months; p = 0.56) vs. SRS alone (13.6 months). CONCLUSION NSCLC patients with brain metastases harboring EGFR or ALK mutations have superior OS compared to wild-type patients. No PFS or OS benefit was found with the addition of TKIs to RT.

中文翻译：

---

EGFR 或 ALK 突变的非小细胞肺癌脑转移：多学科方法的系统评价和荟萃分析

背景和目的 分析携带 EGFR 或 ALK 突变的脑转移非小细胞肺癌 (NSCLC) 患者的结局，并检查单独使用酪氨酸激酶抑制剂 (TKI) 和单独放疗 (RT) 之间的差异（无论是全脑放疗（ WBRT）或立体定向放射外科（SRS）），或结合 TKI 和 RT。材料和方法 确定了 30 项研究。NSCLC脑转移患者。干预初始 TKI 单独使用可选的挽救 RT、单独 RT 或 TKI 和 RT。对照野生型 NSCLC 和 TKI 分别用于突变和治疗分析。结果总生存期（OS）和颅内无进展生存期（PFS）。设置具有突变信息的研究。结果共纳入2649例患者。与野生型患者（9.9 个月）相比，ALK 和 EGFR 突变患者的中位 OS 显着更高（分别为 48.5 个月，p < 0.0001；和 20.9 个月；p = 0.0006）。TKI 和 RT（28.3 个月）、单独 RT（32.2 个月；p = 0.22）或单独 TKI（23.9 个月；p = 0.2）之间的中位 OS 相似。与单独使用 TKI（13.6 个月）相比，接受 TKI 和 RT 治疗的患者中位 PFS 更高（18.6 个月；p = 0.06），而 TKI 和 RT 与单独 RT（16.9 个月；p = 0.72）之间没有差异。WBRT 和 TKI（23.2 个月；p = 0.72）与单独的 WBRT（24 个月）或 SRS 和 TKI（16.7 个月；p = 0.56）与单独的 SRS（13.6 个月）之间没有发现 PFS 差异。结论 携带EGFR或ALK突变的脑转移NSCLC患者与野生型患者相比具有更好的OS。