Surgical Resection of Brain Metastases from Breast Cancer in the Modern Era: Clinical Outcome and Prognostic Factors

Abstract

Background: Incidence of brain metastases (BM) from breast cancer (BC) is increasing. However, prognostic evaluation and treatment strategies are still a matter of debate. Aim: To describe the clinical outcome of BM from BC treated by neurosurgical resection and to identify the actual prognostic factors in this specific population. Patients and Methods: We retrospectively reviewed all patients (n=49) with BM from BC treated at our institutions by surgical resection, between December 2001 and July 2011. Patient, tumor and treatment characteristics were recorded. Results: Median cerebral progression-free survival (CPFS) was 11.3 months (95% Confidence Interval (CI)=6.0-16.6 months) and median overall survival (OS) was 19.4 months (95% CI=16.1-22.7 months). By multivariate analyses, altered Mini Mental Status (MMS) (CPFS: p=0.012, OS: p=0.009), multiple systemic metastases (CPFS: p=0.020, OS: p<0.001) and absence of post-operative chemotherapy (CPFS: p=0.013, OS: p=0.006) had independent adverse prognostic values. Hormonal receptors, Human epidermal growth factor-2 (HER2) and molecular subtype were not significantly correlated to survival. Conclusion: Surgical resection is an effective treatment in selected patients with BM from BC. MMS, number of systemic metastases and the use of postoperative systemic treatment are associated with better outcome.