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作者

V. Gondi M. Ahluwalia D. Roberge R. Ilic T.T.W. Sio D.M. Trifiletti T.M. Muanz A.M. Krpan Z. Zhu N.R. Ramakrishna J.B. Fiveash P.B. Metellus C.J. Wang J. Jacob J. Yu C.F. Freyschlag T. Csőszi P.D. Brown M. Harat M.P. Mehta

作者单位

¹⁶Medical University of Innsbruck, Innsbruck, Austria ¹²Private Hospital Clairval, Marseilles, France ¹³Willis-Knighton Cancer Center, Shreveport, LA ⁷McGill University, Montreal, QC, Canada ¹¹University of Alabama at Birmingham School of Medicine, Birmingham, AL ¹⁹Bydgoszcz University of Science and Technology, Bydgoszcz, Poland ⁸Specialty Hospital Radiochirurgia Zagreb, Sveta Nedelja, Croatia ¹⁷Semmelweis University, Budapest, Hungary ¹⁵Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China ²Miami Cancer Institute, Baptist Health South Florida, Miami, FL ¹⁰Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL ¹Northwestern University Feinberg School of Medicine, Chicago, IL ³Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada ⁴Clinical Centre of Serbia, Beograd, Serbia ⁶Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL ²¹Herbert Wertheim College of Medicine, Florida International University, Miami, FL ²⁰Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland ¹⁴University Hospitals Pitié-Salpêtrière, Paris, France ¹⁸Mayo Clinic Cancer Center, Rochester, MN ⁵Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ ⁹Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

刊名

International Journal of Radiation Oncology*Biology*Physics

年份

2025

卷号

Vol.123 No.4

页码

1196-1197

ISSN

0360-3016

摘要

Purpose/Objective Local therapy for NSCLC BM includes resection, SRS and whole brain radiotherapy . Intracranial progression after resection or SRS is more frequent than with WBRT, but WBRT causes more neurotoxicity and neurocognitive decline. Delaying intracranial failure while preserving neurocognition is an unmet need. TTFields, electric fields delivered via scalp-placed arrays that disrupt cancer cell division, have demonstrated efficacy in glioblastoma, NSCLC and pancreatic cancer. Material...更多

Purpose/Objective Local therapy for NSCLC BM includes resection, SRS and whole brain radiotherapy . Intracranial progression after resection or SRS is more frequent than with WBRT, but WBRT causes more neurotoxicity and neurocognitive decline. Delaying intracranial failure while preserving neurocognition is an unmet need. TTFields, electric fields delivered via scalp-placed arrays that disrupt cancer cell division, have demonstrated efficacy in glioblastoma, NSCLC and pancreatic cancer. Materials/Methods In the METIS trial , adults with 1–10 newly diagnosed NSCLC BM suitable for SRS and receiving optimal therapy for extracranial disease were eligible. Prior WBRT, presence of known druggable mutations, single operable or recurrent BM were exclusion criteria. Patients were randomized 1:1 to SRS followed by TTFields therapy or SRS alone. A blinded independent radiology review committee assessed radiographic progression. The primary endpoint of time to intracranial progression was analyzed using cumulative incidence competing risk and Fine-Gray test to determine a difference. Secondary endpoints included time to distant progression , neurocognitive function, overall survival , quality of life and safety. Results The trial enrolled 298 pts : median age 63 vs 64 years; KPS ≥80 81% vs 91%; median time from NSCLC diagnosis 1.5 vs 2.2 months; adenocarcinoma 75% vs 79%. Median duration of TTFields therapy was 15.7 weeks; median monthly usage was 67.1% . Time to first intracranial progression from SRS was significantly delayed with TTFields therapy . Intracranial progression rates at months 2, 6, 12, and 24 were 13.6% vs 22.1% , 33.7% vs 46.4% , 46.9% vs 59.4% , and 53.6% vs 65.2% . In the 118 pts receiving immune checkpoint inhibitors for their primary disease, TTIP benefit was more pronounced . While no difference in TTDP was observed overall , in pts receiving ICI, TTFields therapy delayed TTDP compared with SRS alone . Time to neurocognitive failure, OS and radiological response rate did not differ significantly. Device-related AEs were mainly grade ≤2 skin events. TTFields did not cause QoL deterioration, and improvements in deterioration-free survival and time to deterioration of global health status, physical functioning and fatigue were observed . Conclusion By significantly prolonging time to intracranial progression, without deteriorating QoL or cognitive function, TTFields therapy after SRS is a potential new treatment option for pts with NSCLC BM. .收起

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