SRT联合拉帕替尼治疗HER2阳性乳腺癌脑转移疗效及预后分析

目的 探讨立体定向放射治疗(Stereotactic radiotherapy,SRT)联合拉帕替尼治疗HER2阳性乳腺癌脑转移的疗效及预后。方法 回顾性分析91例HER2阳性乳腺癌脑转移患者接受拉帕替尼靶向治疗的同时接受全脑放疗或SRT的情况,其中42例患者接受SRT的同时进行拉帕替尼联合卡培他滨治疗(SRT组),另外49例患者采用全脑放疗同时进行拉帕替尼联合卡培他滨治疗(全脑放疗组)。评价其疗效和毒性,定期随访,并行多因素Cox回归分析其预后相关因素。结果 放疗结束后1月SRT组脑部病灶客观缓解率为92.86%(39/42),全脑放疗组客观缓解率为77.55%(38/49),SRT组优于全脑放疗组(χ²=4.070,P=0.044)。SRT组和全脑组12个月受照射肿瘤病灶无进展生存率分别为95.20%及83.10%, SRT组优于全脑放疗组(χ²=10.851,P=0.001)。 SRT组无颅内转移生存率与全脑放疗组无统计学差异(P＞0.05)。SRT组和全脑放疗组1年生存率分别为85.70%和69.40%,2年生存率分别为66.70%和55.10%,两组中位生存期分别为31.56个月和25.00个月,SRT组优于全脑放疗组(P=0.002)。多因素Cox回归分析结果表明无颅外转移(HR=0.527,95% CI:0.290~0.957,P=0.035),颅内病灶≤3个(HR=2.457,95% CI:1.223~4.933,P=0.012),放疗方式SRT(HR=1.746,95% CI:1.055~2.888,P=0.030)是HER2阳性乳腺癌脑转移放疗预后的独立保护因素。结论 SRT联合拉帕替尼在局部控制率以及生存率上优于全脑放疗联合拉帕替尼。颅内病灶个数少、无颅外转移灶和放疗方式是HER2阳性乳腺癌脑转移治疗的良好预后因素。

Efficacy and prognosis of SRT combined with lapatinib in the treatment of HER2-positive breast cancer brain metastasis

Objective The aim of this study was to investigate the efficacy and prognosis of stereotactic radiotherapy(stereotactic radiotherapy,SRT)combined with lapatinib in the treatment of HER2-positive breast cancer brain metastasis. Methods A total of 91 patients with HER2-positive breast cancer brain metastases receiving lapatinib targeted therapy and whole brain radiotherapy or SRT were retrospectively analyzed.Forty-two patients received SRT and lapatinib combined with capecitabine treatment(SRT group)and another 49 patients were treated with whole brain radiotherapy and lapatinib combined with capecitabine.Curative effect and toxicity were further evaluated.Regular follow-up The related prognostic factors of patients were analyzed by multivariate Cox ragression. Results The objective response rate of brain lesions in the SRT group was 92.86%(39/42)after the end of radiotherapy;the objective response rate of the whole brain radiotherapy group was 77.55%(38/49),and the SRT group was better than the whole brain radiotherapy group(χ²=4.070,P=0.044).The Irradiated lesions progression free survival rates of 12 months in the SRT group and whole brain group were 95.20% and 83.10%,respectively.The SRT group was better than the whole brain radiotherapy group(χ²=10.851,P=0.001).There was no significant difference in the intracranial metastasis rate between the SRT group and whole brain radiotherapy group.The 1-year survival rates of the SRT group and whole brain radiotherapy group were 85.70%,69.40%,and the 2-year survival rates were 66.70% and 55.10%,respectively.The median survival time of the two groups was 31 months and 25 months,respectively.The SRT group was better than that in the whole brain radiotherapy group(P=0.002).Cox multivariate analysis showed no extracranial metastasis(HR=0.527,95% CI:0.290~0.957,P=0.035),intracranial lesions ≤3(HR= 2.457,95% CI:1.223~4.933,P=0.012),The radiotherapy SRT(HR=1.746,95% CI:1.055-2.888,P=0.030)was an independent protective factors for the prognosis of radiotherapy for brain metastases from HER2-positive breast cancer. Conclusion SRT combined with lapatinib is superior to whole brain radiotherapy combined with lapatinib in terms of local control rate and survival.Few intracranial lesions and no extracranial metastases and radiotherapy SRT is a good prognostic factor for the treatment of brain metastases from HER2-positive breast cancer.