Radiographic markers of breast cancer brain metastases: relation to clinical characteristics and postoperative outcome

Abstract

Objective Occurrence of brain metastases BM is associated with poor prognosis in patients with breast cancer (BC). Magnetic resonance imaging (MRI) is the standard of care in the diagnosis of BM and determines further treatment strategy. The aim of the present study was to evaluate the association between the radiographic markers of BCBM on MRI with other patients’ characteristics and overall survival (OS). Methods We included 88 female patients who underwent BCBM surgery in our institution from 2008 to 2019. Data on demographic, clinical, and histopathological characteristics of the patients and postoperative survival were collected from the electronic health records. Radiographic features of BM were assessed upon the preoperative MRI. Univariable and multivariable analyses were performed. Results The median OS was 17 months. Of all evaluated radiographic markers of BCBM, only the presence of necrosis was independently associated with OS (14.5 vs 22.5 months, p = 0.027). In turn, intra-tumoral necrosis was more often in individuals with shorter time interval between BC and BM diagnosis (< 3 years, p = 0.035) and preoperative leukocytosis (p = 0.022). Moreover, dural affection of BM was more common in individuals with positive human epidermal growth factor receptor 2 status (p = 0.015) and supratentorial BM location (p = 0.024). Conclusion Intra-tumoral necrosis demonstrated significant association with OS after BM surgery in patients with BC. The radiographic pattern of BM on the preoperative MRI depends on certain tumor and clinical characteristics of patients.

Time interval between the diagnosis of breast cancer and brain metastases impacts prognosis after metastasis surgery

“…Except for TI, which remains the contrary discussed survival predictor, other significant results of our study are in line with current evidence in the literature. So, higher age [ 2 , 6 ] and tumor subtype [ 2 ], Trastuzumab therapy [ 1 , 22 ], brain radiation [ 18 ], and tumor necrosis [ 20 ] are acknowledged survival predictors for BC BM patients undergoing surgery. Moreover, the relevance of these factors has also been shown for survival prognosis and treatment response of different cancer types, particularly with regard to patients’ age and adjuvant therapy [ 18 ].…”

“…Moreover, the relevance of these factors has also been shown for survival prognosis and treatment response of different cancer types, particularly with regard to patients’ age and adjuvant therapy [ 18 ]. In addition, the association of tumor necrosis in MRI with poor tumor control after Gamma Knife radiosurgery of lung cancer BM has also been reported [ 20 , 23 ].…”

“…All female patients (age ≥ 18 years) who underwent BC BM surgery between January 2008 and December 2019 in a single institution were included. The selection process of individuals for BC BM surgery within the institutional interdisciplinary neuro-oncologic tumor board was reported previously [ 19 , 20 ]. Patients with synchronous cerebral metastases were excluded from the study.…”

“…The following patient and tumor characteristics were collected from the electronic health records: patients’ previous medical history (documented comorbidities) and specific laboratory parameters at admission to assess the presence of anemia (hemoglobin), renal function (creatinine), and inflammatory status (white blood cells); BC-related variables: time of BC diagnosis, the type of surgical and (neo-) adjuvant treatment, histopathological features (invasive ductal, invasive lobular), tumor stage, and RS; BM-related variables: time of BM diagnosis, preoperative Karnofsky performance status (KPS) scale, number (singular vs. multiple) and location of BM, RS, and radiographic features in the preoperative magnetic resonance imaging (MRI) as reported previously [ 20 ]. In addition, all available follow-up data after BM surgery was recorded to assess the patients’ OS.…”

Morphological Features as Prognostic Indicators in Brain Metastases

“…The diagnostic and prognostic value of quantitative imaging has been extensively demonstrated in numerous studies [6][7][8] . While several authors have qualitatively identi ed prognostic factors for BMs [9][10][11] , and others have explored the presence of necrosis in surgically treated BMs 12 , the investigation of quantitative prognostic indicators for local control after SRT remains limited 13 . Therefore, the primary objective of this chapter is to evaluate speci c geometric features extracted from contrast-enhanced (CE) T1-weighted (T1w) MR images obtained at baseline or within 12 weeks after SRT.…”