Abstract
The vast majority of patients with brain metastases from breast cancer have extracranial metastases, e.g., in the liver, lungs or bones, with serious impact on prognosis. Limited research has been performed on patients with brain-only disease. We analyzed patterns of treatment, brain control and survival in uni- and multivariate analyses. All 25 patients with brain-only disease were treated with radiotherapy (whole-brain radiotherapy (WBRT) with or without stereotactic radiotherapy/radiosurgery (SRS) or surgical resection) and most patients with systemic treatment later during the disease trajectory. Only a minority of patients remained free from brain progression at 1 year after their initial therapy, regardless of initial treatment approach (median brain progression-free survival 6.2 months). However, overall survival was significantly better after initial surgical resection/SRS as compared to upfront WBRT (median 24.1 and 5.2 months, respectively). For all patients combined, median survival was 11.7 months (2-year survival rate 28 %). Several prognostic factors for shorter survival were identified in multivariate regression analysis: lower KPS, triple-negative tumor, coordination deficit, older age, lack of upfront surgical resection or SRS, and lack of endocrine or HER2-directed therapy after brain metastases treatment. Although durable brain control and long-term survival beyond 5 years could be achieved in a subset of patients (largely after successful salvage), progression of brain metastases during the first year after diagnosis was common. Prognosis was influenced by patient-, disease- and treatment-related factors.
Highlights
Patients with newly diagnosed breast cancer often present with clinically localized stage I or II disease and have low rates of disease recurrence, especially in the brain
Treatment consisted of whole-brain radiotherapy (WBRT), surgery, stereotactic radiotherapy/radiosurgery (SRS) or combinations thereof
Our definition of brain progression included the following events: new brain metastases or leptomeningeal enhancement, local relapse after surgical resection or after RT had resulted in complete remission, progression of previously treated lesions that never displayed complete remission
Summary
Patients with newly diagnosed breast cancer often present with clinically localized stage I or II disease and have low rates of disease recurrence, especially in the brain. Arvold et al (2012) reported a study of more than 1400 patients treated with breast-conserving therapy. Breast cancer subtype has been shown to correlate with risk of brain metastases. Aversa et al (2014) reported that patients with luminal tumors had the lowest risk. In one of the largest studies with pooled data from 24 member institutions of the Japan Clinical Oncology Group, 1256 patients with brain metastases were included (Niikura et al 2014). Patients with asymptomatic brain disease or HER2-positive/estrogen receptor-positive tumors had increased survival. In line with these results, Aversa et al (2014) reported that median survival after diagnosis of brain metastases was shortest in patients with triple-negative tumors. Having isolated brain metastases predicted significantly reduced risk of death [hazard ratio (HR) 0.37, p < 0.004] in their study
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