Brain metastases in breast cancer: prognostic factors and management

Risk factors for brain relapse in HER2-positive metastatic breast cancer patients

“…The median survival in this series was 3.2 years and the median survival from the diagnosis of brain relapse-9 months. Despite adverse prognostic impact of HER2 overexpression or amplification, these results seem to be better compared to those reported previously in unselected series of advanced breast cancer [41][42][43]. This may be related to more effective systemic therapy of advanced breast cancer, particularly the use of trastuzumab, more effective management of brain metastases and improved supportive care.…”

The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases.

“…Although there have been conflicting findings, numerous variables have been shown to have some prognostic value including the following: Basal subtype (20,21,51); whole brain radiation dose of greater than or equal to 30 Gy (20,22); KPS (19,(22)(23)(24)(25)(26)(27)(28)(29)(30); presence/degree of extracranial metastases (21-23,27,30,31); primary tumor control (24,32); size of primary tumor (22); interval from first cancer diagnosis to brain metastases (23); number of brain metastases (22,23,32,33); solitary metastasis (22,34); age (19,21,24,30,34); ER status (21,24,26); HER2 expression (22,24,29,30,32,35); systemic chemotherapy (28); lymphopenia (29,36); and surgical resection (28,31).…”

“…Multiple studies have demonstrated tumor subtype affects prognoses (16)(17)(18), however, neither the RTOG-RPA classification system nor the current Breast-Specific GPA system include tumor subtype in their models. Many other authors have described other prognostic factors, albeit with conflicting findings (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Gaspar et al published a seminal work on a prognostic index for patients with brain metastases, the Radiation Therapy Oncology Group's Recursive Partitioning Analysis (RTOG-RPA) in 1997 (38).…”

Brain Metastases in Breast Cancer

“…Other prognostic factors for brain metastasis include size of the primary tumor (42), interval from the first cancer diagnosis to brain metastases (44), number of brain metastases (42,44 -46), presence of a solitary metastasis (42), age (35,36), ER status (42,47), administration of systemic chemotherapy (8,38), whole-brain radiation dose of 30 Gy or greater (42) and the presence and degree of extracranial metastases (36,42).…”