Abstract
Background: The role of stereotactic radiosurgery (SRS) in the treatment of limited numbers of brain metastases in selected breast cancer patients is well-established.Aims: To analyse outcome from a single institutional experience with SRS, to identify any significant prognostic factors and to assess the influence of Her-2, estrogen receptor status, and prescribed dose on outcome.Methods: The medical records of 56 patients treated at in a single institution between 2009 and 2014 were reviewed. Demographic, treatment related and outcome data were analyzed to identify prognostic factors in this patient population. The primary endpoints were overall survival and local control. Secondary endpoint was distant intra-cranial progression-free survival.Results: The median follow- up time for the entire cohort was 10.33 months (1.25–97.28). The overall median survival was 12.5months (95%CI = 5.8–19.2), with 53.3%, and 35.8% surviving at 1- and 2- years post-SRS. After adjustment for the effect of Her 2 status, uncontrolled extra-cranial disease at the time of SRS predicted for shorter survival (HR for death = 3.1, 95% CI = 1.4–6.9, p = 0.006). At the time of death, 75% of the patients had active, uncontrolled intra-cranial disease, with 56% these patients presenting intra-cranial disease only. Sustained local control was observed in 56 (59.6%) of 94 treated metastases. In univariate analysis, Her2 status, ERHer2 group status?, and prescribed SRS dose were highly significant for local progression free-survival (LPFS). After adjustment for the effect of Her 2 status, patients receiving 12–16 Gy can expect shorter LPFS than those receiving 18–20 Gy (HR = 1.7, 95% CI = 1.0–2.8, p = 0.043). After adjustment for the effect of dose group, patients with Her 2 negative cancer can expect shorter LPFS than those with Her 2 positive cancer (HR = 2.6, 95% CI = 1.5–4.4, p < 0.0005). Use of prior WBRT did not impact survival, local or distant intra-cranial progression-free survival.Conclusions: Survival outcome is similar to the published literature. Improved outcomes are observed in patients with Her 2-positive, controlled extracranial disease at the time of SRS and higher SRS dose delivered. Achieving intra-cranial control appears to be an important factor for the survival of the breast cancer patients in the era of targeted therapies.
Highlights
Brain Metastases occur in 20–40% of patients with metastatic cancer [1]
A retrospective analysis was performed on 56 patients with metastatic breast cancer with metastases to the brain
The overall median survival was 12.5 months, with 53.3%, and 35.8% surviving at 1- and 2- years postSRS (Figure 1), with a small proportion (5–20%) surviving more than 5 years after the initial SRS
Summary
Brain Metastases occur in 20–40% of patients with metastatic cancer [1]. Whole brain radiotherapy (WBRT) and steroid therapy have historically been used as the standard management. The biggest disadvantage with WBRT is that it doesn’t result in a high prolonged local control rate, which contributes to overall low survival. Due to this limitation of WBRT investigators explored the use of surgical removal of oligometastatic (limited number) brain metastases in selected patients. Patchell et al reported a median survival of 19 months in patients treated for solitary brain metastases, with surgical resection and WBRT compared to 9 months in those treated with WBRT alone [4] This trial which included patients with breast and other primary sites demonstrated the potential value of aggressive local intervention for oligometastatic brain tumors in patients with good performance status and controlled extracranial disease. The role of stereotactic radiosurgery (SRS) in the treatment of limited numbers of brain metastases in selected breast cancer patients is well-established
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