title: [Timing of Brain Radiation Therapy Impacts Outcomes in Patients with  Non-small Cell Lung Cancer Who Develop Brain Metastases].
abstract: BACKGROUND
  Radiotherapy combined with chemotherapy or molecular targeted therapy remains the standard of treatment for brain metastases from non-small cell lung cancer (NSCLC). The aim of this study is to determine if the deferral of brain radiotherapy impacts patient outcomes.
  
  
  METHODS
  Between May 2003 and December 2015, a total of 198 patients with brain metastases from NSCLC who received both brain radiotherapy and systemic therapy (chemotherapy or targeted therapy) were identified. The rate of grade 3-4 adverse reactions related to chemotherapy and radiotherapy had no significant difference between two groups. 127 patients received concurrent brain radiotherapy and systemic therapy, and 71 patients received deferred brain radiotherapy after at least two cycles of chemotherapy or targeted therapy. Disease specific-graded prognostic assessment was similar in early radiotherapy group and deferred radiotherapy group.
  
  
  RESULTS
  Median overall survival (OS) was longer in early radiotherapy group compared to deferred radiotherapy group (17.9 months vs 12.6 months; P=0.038). Progression free survival (PFS) was also improved in patients receiving early radiotherapy compared to those receiving deferred radiotherapy (4.0 months vs 3.0 months; P<0.01). Receiving tyrosine kinase inhibitor (TKI) therapy after the diagnosis of brain metastases as any line therapy improved the OS (20.0 months vs 10.7 months; P<0.01), whereas receiving TKI as first line therapy did not (17.9 months vs 15.2 months; P=0.289).
  
  
  CONCLUSIONS
  Our study suggests that the use of deferred brain radiotherapy may resulted in inferior OS in patients with NSCLC who develop brain metastases. A prospective multi-central randomized study is imminently needed.
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Yang
authors: Y
authors: Wang
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Jian
authors: J
authors: Fang
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Jun
authors: J
authors: Nie
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Ling
authors: L
authors: Dai
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Weiheng
authors: W
authors: Hu
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Jie
authors: J
authors: Zhang
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Xiangjuan
authors: X
authors: Ma
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Jindi
authors: J
authors: Han
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Xiaoling
authors: X
authors: Chen
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Guangming
authors: G
authors: Tian
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Di
authors: D
authors: Wu
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Sen
authors: S
authors: Han
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the Second Department of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors: Jieran
authors: J
authors: Long
mesh_terms: D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D013997:Time Factors; D016896:Treatment Outcome