Impact of preexisting tumor necrosis on the efficacy of stereotactic radiosurgery in the treatment of brain metastases in women with breast cancer

Abstract

BACKGROUND: Breast cancer is the second most common source of brain metastasis. Stereotactic radiosurgery (SRS) can be an effective treatment for some patients with brain metastasis (BM). Necrosis is a common feature of many brain tumors, including BM; however, the influence of tumor necrosis on treatment efficacy of SRS in women with breast cancer metastatic to the brain is unknown. METHODS: A cohort of 147 women with breast cancer and BM treated consecutively with SRS over 10 years were studied. Of these, 80 (54.4%) had necrosis identified on pretreatment magnetic resonance images and 67 (46.4%) did not. Survival times were computed using the Kaplan-Meier method. Log-rank tests were used to compare groups with respect to survival times, Cox proportional hazards regression models were used to perform univariate and multivariate analyses, and chi-square and Fisher exact tests were used to compare clinicopathologic covariates. RESULTS: Neurological survival (NS) and survival after SRS were decreased in BM patients with necrosis at the time of SRS compared with patients without necrosis by 32% and 27%, respectively (NS median survival, 25 vs 17 months [log-rank test, P ¼ .006]; SRS median survival, 15 vs 11 months [logrank test, P ¼ .045]). On multivariate analysis, HER2 amplification status and necrosis influenced NS and SRS after adjusting for standard clinical features, including BM number, size, and volume as well as Karnofsky performance status. CONCLUSION: Neuroimaging evidence of necrosis at the time of SRS significantly diminished the efficacy of therapy and was a potent prognostic marker.

Czynniki prognostyczne u chorych z przerzutami raka piersi do mózgu

“…Kontrowersje budzi również prognostyczne znaczenie liczby BM u chorych z BMBC [4, 22, 24, 25, 30, 36, 56, 58-61, 63-65, 68-71, 75, 76]. Część autorów wykazuje prognostyczne znaczenie tego czynnika w analizach jedno-lub wieloczynnikowych [4,5,12,15,25,40,60,62,63,69], a wielu nie wykazuje zupełnie [14, 22, 24, 37-39, 43-45, 48, 53, 65]. Należy podkreślić, że liczba BM odgrywa istotną rolę przy wyborze leczenia lokalnego (chirurgia, SRS) lub lokoregionalnego (WBRT).…”

“…W piśmiennictwie istnieje pewna liczba doniesień sugerujących potencjalną wartość prognostyczną wieku chorych z BMBC, opartych na analizach jedno-i wieloczynnikowych [1,2,4,40,[58][59][60]69]. Za wartość różnicującą rokowniczo najczęściej przyjmuje się wiek 60 lub 65 lat [30,58,69], rzadziej 50 lat [36,70], jednak obserwacje wielu autorów nie potwierdzają prognostycznego znaczenia wieku u chorych z BMBC [1,22,25,40,58,59,63,64,68,77].…”

“…W nielicznych doniesieniach w piśmiennictwie pojawia się wiele innych potencjalnych czynników prognostycznych, takich jak np. czas, jaki upływa od diagnozy BC do pojawienia się BM [25,55,56,65], liczba narządów poza mózgiem z przerzutami odległymi [38], obecność przerzutów do wątroby [5,19,60], obecność objawów neurologicznych [24], lokalizacja BM w głębokich strukturach mózgu [25], martwica w BMBC [40], wymiar największego BM lub suma objętości przerzutów [24,25,40,55], limfopenia [7,61,68], poziom dehydrogenazy mleczanowej (LDH) i albumin w surowicy krwi [67] itd.…”

Role of Amide Proton Transfer (APT)-MRI of Endogenous Proteins and Peptides in Brain Tumor Imaging

“…These components in malignant brain tumors modify the sensitivity to ionizing radiation, affecting the prognosis. It has been indicated that the overall survival time after radiotherapy for brain tumors is decreased by 27 % in patients with necrosis compared with the patients without necrosis [28]. Therefore, determination of cellular components is another major aim of brain tumor imaging.…”

Radiosensitization of Allogenic Subcutaneous C6 Glioma Model with Focused Ultrasound-Induced Mild Hyperthermia

“…The standard treatment for glioblastoma multiforme (GBM) is surgical resection followed by chemoradiotherapy, with radiotherapy usually distributed over 6 weeks in 2 gray (Gy) fractions for a total dose of 40–60 Gy, or more focally with SRS in fewer fractions and at higher doses per fraction (15 + Gy) [ 1 ]. However, many brain tumors are less amenable to a favorable radiation response, including diffuse tumors such as GBM [ 3 ] and tumors with areas of central necrosis and hypoxia [ 4 ]. Because of the infiltrative nature of GBM, regional recurrence of the initial tumor remains a potent cause of relapse [ 5 ].…”