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. 2025 Jun 7;16(1):1023.
doi: 10.1007/s12672-025-02780-0.

The effect of radiotherapy on patients with EGFR-driven lung cancer brain metastasis: a systematic review and meta-analysis

Mohammad Amin Habibi  1 , Farhang Rashidi  2 , Pourya Delbari  2 , Bardia Hajikarimloo  3 , Seyed Hesam Hojjat  4 , Sana Kazemivand  2 , Sahar Fathi Tavani  2 , Amirmohammad Bahri  5 , Mohammad Shahir Eftekhar  6 , Hossein Gandomkar  7 , Ibrahim Mohammadzadeh  8
Affiliations

The effect of radiotherapy on patients with EGFR-driven lung cancer brain metastasis: a systematic review and meta-analysis

Mohammad Amin Habibi et al. Discov Oncol. .

Abstract

Background: Brain metastases (BMs) are a common and fatal consequence in patients with advanced malignancies. Mutations happening in the epidermal growth factor receptor (EGFR) are associated with an elevated risk BMs, occurring in approximately 20-40% of patients. This study evaluates the safety and efficacy of different radiotherapy (RT) modalities in patients with EGFR-mutant lung cancer brain metastases.

Method: This study was conducted according to the PRISMA guideline. A comprehensive search was conducted on PubMed, Embase, Web of Science, and Scopus, until 13 March 2024. Stata v.17 was used for statistical analysis.

Result: A total of 57 studies involving 4614 patients were analyzed, with a female predominance of 59.55% and a mean age of 50-70 years. The 6-month overall survival (OS) rate was 94% [95% CI 91-96%], 81% [95% CI 78- 84%] at 1-year, 55% [95% CI 50-60%] at 2-year, 37% [95% CI 32-42%] at 3-year, decreasing to 21% [95% CI 16-26%] at 5 years. Progression-free survival (PFS) rates were 84% [95% CI 79-89%] at 6 months and 20% [95% CI 14-26%] at 3 years. Meta-regression analysis indicated that a higher number of metastases, Karnofsky performance status below 80, and an ECOG score over one were significantly linked to OS outcomes.

Conclusion: RT significantly improves survival outcomes in patients with EGFR-mutant brain metastases. However, the combination of RT with targeted therapies, such as tyrosine kinase inhibitors (TKIs), appears to offer more favorable outcomes.

Keywords: Brain metastases; EGFR mutations; Non-small cell lung cancer; Radiotherapy; Stereotactic.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study is deemed to exempt to receive ethical approval. Consent to participate: Not applicable. Human ethics and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The impact of EGFR mutation on immune cells
Fig. 2
Fig. 2
PRISMA Flowchart
Fig. 3
Fig. 3
a. 6-Month Overall Survival (OS) Rate. b. 1-year Overall Survival (OS) Rate. c. 2-year Overall Survival (OS) Rate. d. 3-year Overall Survival (OS) Rate. e. 5-year Overall Survival (OS) Rate
Fig. 3
Fig. 3
a. 6-Month Overall Survival (OS) Rate. b. 1-year Overall Survival (OS) Rate. c. 2-year Overall Survival (OS) Rate. d. 3-year Overall Survival (OS) Rate. e. 5-year Overall Survival (OS) Rate
Fig. 3
Fig. 3
a. 6-Month Overall Survival (OS) Rate. b. 1-year Overall Survival (OS) Rate. c. 2-year Overall Survival (OS) Rate. d. 3-year Overall Survival (OS) Rate. e. 5-year Overall Survival (OS) Rate
Fig. 3
Fig. 3
a. 6-Month Overall Survival (OS) Rate. b. 1-year Overall Survival (OS) Rate. c. 2-year Overall Survival (OS) Rate. d. 3-year Overall Survival (OS) Rate. e. 5-year Overall Survival (OS) Rate
Fig. 3
Fig. 3
a. 6-Month Overall Survival (OS) Rate. b. 1-year Overall Survival (OS) Rate. c. 2-year Overall Survival (OS) Rate. d. 3-year Overall Survival (OS) Rate. e. 5-year Overall Survival (OS) Rate
Fig. 4
Fig. 4
a. 6-Month PFS Rate. b. 12-Month Progression-free survival (PFS) Rate. c. 18-Month Progression-free survival (PFS) Rate. d. 2-year Progression-free survival (PFS) Rate. e. 3-year Progression-free survival (PFS) Rate
Fig. 4
Fig. 4
a. 6-Month PFS Rate. b. 12-Month Progression-free survival (PFS) Rate. c. 18-Month Progression-free survival (PFS) Rate. d. 2-year Progression-free survival (PFS) Rate. e. 3-year Progression-free survival (PFS) Rate
Fig. 4
Fig. 4
a. 6-Month PFS Rate. b. 12-Month Progression-free survival (PFS) Rate. c. 18-Month Progression-free survival (PFS) Rate. d. 2-year Progression-free survival (PFS) Rate. e. 3-year Progression-free survival (PFS) Rate
Fig. 4
Fig. 4
a. 6-Month PFS Rate. b. 12-Month Progression-free survival (PFS) Rate. c. 18-Month Progression-free survival (PFS) Rate. d. 2-year Progression-free survival (PFS) Rate. e. 3-year Progression-free survival (PFS) Rate
Fig. 4
Fig. 4
a. 6-Month PFS Rate. b. 12-Month Progression-free survival (PFS) Rate. c. 18-Month Progression-free survival (PFS) Rate. d. 2-year Progression-free survival (PFS) Rate. e. 3-year Progression-free survival (PFS) Rate
Fig. 5
Fig. 5
a. Complete Response Rate. b. Overall Response Rate. c. Partial Response Rate. d. Progressive Disease Rate. e. Stable Disease Rate
Fig. 5
Fig. 5
a. Complete Response Rate. b. Overall Response Rate. c. Partial Response Rate. d. Progressive Disease Rate. e. Stable Disease Rate
Fig. 5
Fig. 5
a. Complete Response Rate. b. Overall Response Rate. c. Partial Response Rate. d. Progressive Disease Rate. e. Stable Disease Rate
Fig. 5
Fig. 5
a. Complete Response Rate. b. Overall Response Rate. c. Partial Response Rate. d. Progressive Disease Rate. e. Stable Disease Rate
Fig. 5
Fig. 5
a. Complete Response Rate. b. Overall Response Rate. c. Partial Response Rate. d. Progressive Disease Rate. e. Stable Disease Rate
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