P4-17-11: Central Nervous System Involvement and Clinical Outcome, Review of 135 Patients, 9-Year Follow Up.

Abstract

Abstract Background: Breast cancer infiltrates into central nervous system (CNS) with the incidence of 10–20%. It is commonly accepted CNS screening does not contribute to maintain patients’ survival in metastatic breast cancer (MBC). We review our MBC cases with CNS involvement with the aim of searching prognostic factors and evaluating benefits derived from early detection of CNS lesion. Patients and Methods: From October 2002 to January 2011, 473 MBC patients treated at our hospital were reviewed and assessed. CNS lesion was found in 133 of 473 (28.5%) mostly by magnetic resonance imaging. Receptor statuses in patients with CNS disease were as follows; Estrogen receptor-positive 52.4%, HER2−positive 41.1% and triple-negative 12.7%. Asymptomatic patient at the diagnosis of CNS metastasis, in other words, CNS screening performed case, was 57.8%. Liver metastasis prior to CNS involvement was observed in 51.2% of patients. Results: Within our 9-year follow-up, 122 patients received irradiation or operation, and 118 died. While major cause of death was lung or liver failure, 23.7% was considered as CNS death. Median overall survival from the diagnosis of primary breast cancer, survival from the MBC development and survival from CNS involvement were 1951, 1027 and 321 days respectively. Patients having HER2−disease showed superior survival after detection of CNS disease than HER2−negative patients. (median 514.0 vs 220.0 days, p=0.001) Asymptomatic patients, excluding underwent best supportive care (BSC), could not receive any survival benefit from early detection of CNS lesion. Liver metastasis prior to CNS involvement did not affect patients’ survival. Nineteen patients (14.1%), 17 of them were asymptomatic, received stereotactic irradiation as an initial treatment for CNS lesion, and showed superior survival after CNS event than patients received whole brain irradiation, surgery or BSC (median 670.0 vs 287.0 days, p=0.01). Conclusion: Our review disclosed superior survival of HER2−disease with CNS metastasis. Early detection of CNS metastasis is only beneficial to patients when stereotactic irradiation will be suited for. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-17-11.