Treatment and prognosis of brain metastases from breast cancer

Ogawa, Kazuhiko; Yoshii, Yoshihiko; Nishimaki, Tadashi; Tamaki, Nobuharu; Miyaguni, Takao; Tsuchida, Yukihiro; Kamada, Yoshihiko; Toita, Takafumi; Kakinohana, Yasumasa; Tamaki, Wakana; Iraha, Shiro; Adachi, Genki; Hyodo, Akio; Murayama, Sadayuki

doi:10.1007/s11060-007-9469-1

Cited by 69 publications

(52 citation statements)

References 33 publications

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“…In comparison to other data in the literature, this interval is slightly shorter; median survival times between 4.5 and 10 months have been reported (12)(13)(14)(15)(16).…”

Section: Discussioncontrasting

confidence: 50%

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

Kühnöl

Vordermark

2016

Oncology Letters

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Abstract. Brain metastases (BM) from breast cancer are associated with high morbidity and a poor prognosis. The aim of this study was to analyse the role of radiotherapy in treatment of BM from breast cancer in the context of modern local therapy modalities, current systemic treatment options and prognostic factors. A retrospective analysis of 86 consecutive female patients treated with radiotherapy for BM from breast cancer between 2000 and 2010 was conducted. Patient and treatment characteristics were registered and survival data calculated. All patients received whole-brain radiotherapy (WBRT) with a median dose of 36 Gy, and 19 patients were treated with an additional boost; this included fractionated schemes (median dose, 18 Gy) and radiosurgery (5 and 17 Gy). The median overall survival time from the start of WBRT was 4.1 months in the present cohort. Patients receiving a boost survived 19.7 months in comparison to 3.1 months for patients treated with WBRT alone (P<0.001). Other factors that improved overall survival, based on a univariate analysis, were dose of WBRT and number of BM. There was no statistical evidence for the influence of the human epidermal growth factor receptor 2 status on survival in the current study. The administration of boost treatment following WBRT was also identified as a significant factor influencing survival on multivariate analysis (P=0.030). In conclusion, radiotherapy affects the survival time of patients with BM from breast cancer. In particular, the implementation of boost treatment following WBRT in selected patients seems to extend survival time. IntroductionThe most common brain tumours are intracranial metastases (1). Over 20% of patients with solid malignant tumours develop brain metastases (BM); patients with small-cell lung cancer (45%), melanomas (45%), non-small-cell lung cancer (30%), breast cancer and renal cancer (20%) have the highest risk for the occurrence of intracranial metastases (2). The incidence of clinically detected BM in patients with metastatic breast cancer is 16-20%, and autopsy studies suggest a prevalence of BM of up to 34% (3-6). A number of risk factors for cerebral metastases in breast cancer patients have been reported in the literature; in addition to young age (<35 years), large primary tumour size (>2 cm)and negative estrogen receptor (ER) status, the overexpression of human epidermal growth factor receptor 2 (HER2) has been demonstrated to be associated with a higher risk of BM (7-10).The management of BM includes radiotherapeutic, surgical and medical options. Consideration of a local treatment modality depends on the number of intracranial metastases and potential local complications resulting from their location and size. Patients with multiple BM typically receive whole-brain radiotherapy (WBRT), whilst neurosurgery or stereotactic radiosurgery (SRS) are possible treatment options for patients with a single BM. The application of intrathecal chemotherapy may be selected as the therapeutic regime in cases with meningeal involvement...

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“…In comparison to other data in the literature, this interval is slightly shorter; median survival times between 4.5 and 10 months have been reported (12)(13)(14)(15)(16).…”

Section: Discussioncontrasting

confidence: 50%

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

Kühnöl

Vordermark

2016

Oncology Letters

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Sperduto¹,

Kased²,

Roberge³

et al. 2011

JCO

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“…Una calificación en Karnofsky ≤70 al diagnóstico, por ejemplo, se ha asociado con un mayor riesgo de muerte por metástasis al SNC. 8,11,15,24 Los resultados del presente estudio son similares a los datos publicados previamente por Anders y colaboradores 25 pues, según los resultados de su trabajo, las metástasis al SNC se presentan principalmente en mujeres que fueron diagnosticadas en etapas localmente avanzadas y con subtipos luminal y TN. En ese mismo trabajo, el tratamiento con QT fue administrado a 89% de las pacientes, en comparación con 99% de este estudio.…”

Section: Discussionunclassified

Factores pronósticos en pacientes con cáncer de mama y metástasis cerebral como primer sitio de recurrencia

et al. 2018

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Objetivo. Evaluar los factores pronósticos (características clínico-patológicas y tratamientos) en las pacientes con cáncer de mama y metástasis al sistema nervioso central (SNC) como primer sitio de afección. Material y métodos. Cohorte retrospectiva, formada por 125 pacientes con cáncer de mama atendidas en el Instituto Nacional de Cancerología durante 2007-2015, quienes presentaron afección en el SNC como primer sitio de metástasis. A través del método Kaplan-Meier y tablas de vida se estimó la supervivencia global. El modelo de riesgos proporcionales de Cox fue utilizado para determinar los factores pronósticos. Resultados. La mediana de supervivencia global fue de 14.2 meses (IC95% 11.8-26.9). Pacientes clasificadas por inmunohistoquímica como triple negativo (TN) presentaron tiempos de supervivencia más cortos (p<0.004) y con dos veces más riesgo de fallecer, en comparación con los otros inmunofenotipos (HR= 2.77; IC95% 1.10-6.99); asimismo, se identificó que un grado intermedio en la escala Scarff-Bloom-Richardson incrementa el riesgo de morir en pacientes con metástasis (HR=2.76; IC95% 1.17- 6.51). Conclusiones. La metástasis al SNC continúa siendo un factor de mal pronóstico que reduce la supervivencia y afecta la calidad de vida. Se recomienda vigilar puntualmente la presencia de manifestaciones clínicas neurológicas durante el seguimiento, para una rápida intervención. Las pacientes TN tienen peor pronóstico, y las HER2+ (es decir, con resultado positivo para el receptor 2 del factor de crecimiento humano epidérmico), mejor control a mediano plazo.

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Treatment and prognosis of brain metastases from breast cancer

Cited by 69 publications

References 33 publications

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

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

Factores pronósticos en pacientes con cáncer de mama y metástasis cerebral como primer sitio de recurrencia

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