Abstract
BackgroundBreast cancer is the second most common cause of brain metastases in the United States. Although breast cancer induced brain metastases represent an incurable condition, some patients experience prolonged survival. In this retrospective study, we examine a cohort of patients with brain metastases from breast cancer treated with Gamma Knife stereotactic radiosurgery to identify factors that predict better outcomes.MethodsA retrospective database of 100 patients treated for brain metastases due to breast cancer via Gamma Knife radiosurgery (GKS) from July 1998 through March 2009 was reviewed. Patients who received radiosurgery as sole treatment, as a planned boost after whole brain radiotherapy or surgical resection, or as salvage after prior whole brain radiation therapy (WBRT) or surgical resection were included. Prognostic factors identified to be significant for survival in previous brain metastasis studies were analyzed for significance by univariate and multivariate Cox analysis.ResultsOverall, the median brain progression-free survival time was 7.1 months and the median survival time was 12.3 months. No prognostic variables were significant for brain progression-free survival. For patients treated with a planned GKS after WBRT, GKS as sole treatment, GKS salvage after WBRT, GKS boost after surgery, or GKS for surgical salvage the median survival times (MSTs) were as follows: 12.2 months, 12.4 months, 9.5 months, 27.6 months and 33.4 months respectively. Differences between the groups were not significant (p = 0.06); however, GKS boost after surgery and GKS for salvage after surgery did have a trend toward better overall survival.The MST for patients of age <65 years was 14.5 months, compared to age ≥65 which was 7.7 months (p = 0.06) and remained a significant prognostic factor for overall survival on multivariate analysis. The MST for patients with a single lesion was 16.9 months, not significantly different than the MST of 14.5 months for patients with 2–3 lesions. However patients with >3 lesions had a MST of 5.9 months, which was significantly worse. Breast cancer subtype as approximated by biomarkers and KPS were not significant predictors of overall survival and stage at initial diagnosis was inversely associated with survival.ConclusionStereotactic radiosurgery offers good local control and prolonged survival in selected patients. Age and number of lesions are strong predictors of overall survival.
Highlights
Breast cancer is the most common cancer among women, and the second most common source of brain metastases in the United States
The Breast Specific Graded Prognostic Assessment (BS-GPA) showed patients with CNS metastases due to breast cancer to have a median survival of 13.8 months, with the most favorable group having a median survival of 25.3 months [5]
Patient characteristics One hundred consecutive breast cancer patients receiving Gamma Knife stereotactic radiosurgery (GKS) for brain metastasis treated between July 1998 and March 2009 were reviewed
Summary
Breast cancer is the most common cancer among women, and the second most common source of brain metastases in the United States. While major advances in the treatment of breast cancer have occurred in the past two decades, a significant number of women will continue to succumb to Supportive care and whole brain radiation therapy (WBRT) have a major role in the management of brain metastasis; the survival of most patients with brain metastasis remains limited. In this population the Radiation Therapy Oncology Group (RTOG) has identified age, performance status, control of the primary tumor, and presence of extracranial disease as prognostic factors for survival [3,4] and created a recursive partitioning analysis (RPA) to predict survival using these factors. We examine a cohort of patients with brain metastases from breast cancer treated with Gamma Knife stereotactic radiosurgery to identify factors that predict better outcomes
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