Abstract
AimTo analyse the use of radiotherapy (RT) and factors affecting overall survival (OS) after RT in breast cancer patients with brain metastases. MethodsBreast cancer patients treated from 2008 to 2018 with whole brain RT (WBRT) or stereotactic radiosurgery (SRS) at a large regional cancer referral center were identified from the hospital's RT register. Clinical variables were extracted from medical records. OS was calculated from date of first RT until death or last follow up. Potential factors affecting OS were analyzed. Results255 females with WBRT (n = 206) or SRS (n = 49) as first RT were included. An increased use of initial SRS was observed in the second half of the study period. The most common WBRT fractionation regimen was 3 Gy × 10. SRS was most often single fractions; 18 or 25 Gy between 2009 and 2016, while fractionated SRS was mostly used in 2017 and 2018. Median OS in the WBRT group was 6 months (CI 1–73) relative to 23 (CI 0–78) in the SRS group. Age, performance status, initial RT technique, extracranial disease, brain metastasis surgery, number of brain metastases and DS-GPA score had significant impact on OS. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis. ConclusionWBRT was the most frequent primary RT. An increased use of initial SRS was observed in the second half of the study period. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis.
Highlights
IntroductionUp to 30% of breast cancer patients are diagnosed with brain metastases, depending on tumor subtype and stage at diagnosis.[1,2,3] Overall, the incidence of brain metastases in breast cancer patients is increasing due to increasing incidence of breast cancer, improved precision and more frequent use of imaging, and better systemic control of extracranial disease leading to prolonged survival time.[4,5,6] Patient involvement, treatment guidelines and prognostic scoring systems may aid treatment decisions in order to choose the most appropriate brain metastasis treatment.[7,8] One of the most recognized prognostic scoring systems for brain metastasis treatment is Diagnosis Specific Graded Prognostic Assessment (DSGPA).[9] The DS-GPA is based on well-known prognostic factors for the specific cancer diagnoses
Other factors previously found to impact on overall survival (OS) in breast cancer patients with brain metastases are number of brain metastases,[11] extracranial disease activity, and factors related to the brain metastasis treatment.[9]
This study aimed to investigate the use of RT and factors affecting OS in breast cancer patients treated for brain metastases at Oslo University HospitalRadiumhospitalet (OUH) during the period of 2008– 2018
Summary
Up to 30% of breast cancer patients are diagnosed with brain metastases, depending on tumor subtype and stage at diagnosis.[1,2,3] Overall, the incidence of brain metastases in breast cancer patients is increasing due to increasing incidence of breast cancer, improved precision and more frequent use of imaging, and better systemic control of extracranial disease leading to prolonged survival time.[4,5,6] Patient involvement, treatment guidelines and prognostic scoring systems may aid treatment decisions in order to choose the most appropriate brain metastasis treatment.[7,8] One of the most recognized prognostic scoring systems for brain metastasis treatment is Diagnosis Specific Graded Prognostic Assessment (DSGPA).[9] The DS-GPA is based on well-known prognostic factors for the specific cancer diagnoses This facilitates therapeutic decisions by classifying patients according to intermediate and least favorable prognosis. In patients with poor prognosis, best supportive care is the recommended treatment.[7]
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