Stereotactic radiosurgery for patients with breast cancer brain oligometastases - molecular subtypes and clinical outcomes.

Abstract

We sought to determine the clinical outcomes of patients with breast cancer (BC) who had undergone stereotactic radiosurgery (SRS) for a limited number of brain metastases (BM) and to identify factors influencing overall survival (OS) and local control. The records of 45 patients who underwent SRS for 72 brain lesions were retrospectively evaluated. Statistics included the chi-squared test, Kaplan-Meier method, and the multivariate Cox model. The median number of treated BM was 2 (range 1-10). Median OS from BM diagnosis and post-SRS were 27.6 [95% confidence interval (CI): 14.8-40.5) and 18.5 months (95% CI: 11.1-25.8), respectively. One-year and two-year survival rates after BM diagnosis were 55% and 41%, respectively. In a univariate analysis, the Luminal-B-human-epidermal-growth-receptor-positive (HER2+) subtype had the longest median OS at 39.1 months (95% CI: 34.1-44.1, p = 0.004). In an adjusted analysis, grade 2 [hazard ratio (HR): 0.1; 95% CI: 0.1-0.6, p = 0.005), craniotomy (HR: 0.3; 95% CI: 0.1-0.7; p = 0.006), and ≥ 2 systemic therapies received (HR: 0.3; 95% CI: 0.1-0.9, p = 0.028) were associated with improved OS. One-year and two-year intracranial progression-free survival rates were 85% and 63%, respectively. Four factors for a higher risk of any intracranial recurrence remained significant in the adjusted analysis, as follows: age < 50 years (HR: 4.2; 95% CI: 1.3-36.3; p = 0.014), grade 3 (HR: 3.7; 95% CI: 1.1-13.2; p = 0.038), HER2+ (HR: 6.9; 95% CI: 1.3-36.3; p = 0.023), and whether the brain was the first metastatic site (HR: 4.7; 95% CI: 1.6-14.5; p = 0.006). Intrinsic BC characteristics are important determinants for both survival and intracranial control for patients undergoing SRS for oligometastatic brain disease.