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We proposed to compare the outcomes of first‐line epidermal growth factor receptor–tyrosine kinase inhibitor ( EGFR ‐ TKI ) alone with  EGFR ‐ TKI  plus whole‐brain radiotherapy ( WBRT ) for the treatment of brain metastases ( BM ) in patients with  EGFR ‐mutated lung adenocarcinoma. A total of 1665 patients were screened from 2008 to 2014, and 132 were enrolled in our study. Among the 132 patients, 72 (54.5%) harbored a deletion in exon 19, 97 (73.5%) showed multiple intracranial lesions, and 67 (50.8%) had asymptomatic  BM . Seventy‐nine patients (59.8%) were treated with  EGFR ‐ TKI  alone, 53 with concomitant  WBRT . The intracranial objective response rate was significantly higher in the  EGFR ‐ TKI  plus  WBRT  treatment group (67.9%) compared with the  EGFR ‐ TKI  alone group (39.2%) ( P  = 0.001). After a median follow‐up of 36.2 months, 62.1% of patients were still alive. The median intracranial  TTP  was 24.7 months (95%  CI , 19.5–29.9) in patients who received  WBRT , which was significantly longer than in those who received  EGFR ‐ TKI  alone, with the median intracranial  TTP  of 18.2 months (95%  CI , 12.5–23.9) ( P  = 0.004). There was no significant difference in overall survival between  WBRT  and  EGFR ‐ TKI  alone groups, (median, 48.0  vs  41.1 months;  P  = 0.740). The overall survival is significantly prolonged in patients who had an intracranial  TTP  exceeding 22 months compared to those who developed intracranial progression &lt;22 months after treatment, (median, 58.0  vs  28.0 months;  P  = 0.001). For  EGFR ‐mutated lung adenocarcinoma patients with  BM , treatment with concomitant  WBRT  achieved a higher response rate of  BM  and significant improvement in intracranial progression‐free survival compared with  EGFR ‐ TKI  alone.

cancer science

First‐line epidermal growth factor receptor ( EGFR )–tyrosine kinase inhibitor alone or with whole‐brain radiotherapy for brain metastases in patients with  EGFR ‐mutated lung adenocarcinoma