Pejorative factors identification for survival in patients with brain metastases from breast carcinoma treated with whole brain radiation therapy

Abstract

10513 Background: To determine overall survival and independent prognostic factors for patients with brain metastases from breast carcinoma treated with whole brain radiation therapy (WBRT). Methods: From January 1998 through December 2003, 132 patients with brain metastases (BM) from breast carcinoma were treated with WBRT (median dose: 3000 cGy/ 10 fractions). We analyzed a number of potential predictors of survival after WBRT: age, presence of other systemic metastases, performance status, RTOG recursive partition analysis (RPA) class (1–2 vs 3), total dose of WBRT, number of brain metastases, interval between primary tumor and brain metastases, SBR score, tumor receptor hormonal (RH) status, lymphocyte count (< 700 vs ≥ 700 G/L), serum lactate dehydrogenase and HER-2 overexpression. The survival time with BM was defined as the time from the date of BM to the date of death or date of last of follow-up. Multivariate analysis was used to determine the effect of prognostic factors on overall survival using the Cox proportional hazard model. Results: One hundred and seventeen patients received exclusive WBRT. Surgery was followed by WBRT in 14 patients and stereotactic radiosurgery was followed by WBRT in 1. The median survival with BM was 6 months (range: 0–52). The 1-year and 2-years survival rates were 31% (CI95%: 23.5–39.8) and 16% (CI95%: 9.8–24.9). In multivariate analysis, RTOG RPA class III, lymphopenia (<700) and negative tumor RH status were independent prognostic factors for poor survival. Moreover, analysis of Her-2 overexpression was performed in 53 patients and 43% BM patients overexpressed Her-2. In preliminary analysis, Her-2 status was not a prognostic factor of survival. A complete analysis is ongoing and will be presented at the meeting. Conclusions: This large study confirms the value of established prognostic factors such as the RTOG RPA score and some less-well recognized factors such as lymphopenia and tumor RH status. No significant financial relationships to disclose.