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Brain metastases in breast cancer: prognostic factors and management

  • Epidemiology
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Abstract

Background The purpose of this retrospective study was to analyze the overall survival of patients with brain metastases due to breast cancer and to identify prognostic factors that affect clinical outcome. Methods Of the 7,872 breast cancer patients histologically diagnosed with breast cancer between January 1990 and July 2006 at the Asan Medical Center, 198 patients with solitary or multiple brain metastases were included in this retrospective study. Central nervous system (CNS) lesions were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). Patients with leptomeningeal or dural metastases without co-existent parenchymal metastatic lesions were excluded in this study. We reviewed the medical records and pathologic data of these 198 patients to characterize the clinical features and outcomes. Results The median age of the patients at the diagnosis of brain metastases was 45 years (range 26–78 years). Fifty-five patients (28%) had a single brain metastasis, whereas 143 (72%) had more than two metastases. A total of 157 (79.2%) patients received whole-brain radiation therapy (WBRT). A total of 7 (3.6%) patients underwent resection of solitary brain metastases, 22 (11%) patients underwent gamma-knife surgery, three patients underwent intrathecal chemotherapy (1.5%) and 9 (4.6%) patients received no treatment. The overall median survival time was 5.6 months (95% confidence interval (CI), 4.7–6.5 months) and 23.1% of the patients survived for more than 1 year. The median overall survival time was 5.4 months for patients treated with WBRT, 14.9 months for patients treated with surgery or gamma-knife surgery only, and 2.1 months for patients who received no treatment (P < 0.001). Multivariate analysis demonstrated that Eastern Cooperative Oncology Group (ECOG) performance status (relative risk (RR) = 0.704, 95% CI 0.482–1.028, P = 0.069), number of brain metastases (RR = 0.682, 95% CI 0.459–1.014, P = 0.058), treatment modalities (RR = 1.686, 95% CI 1.022–2.781, P = 0.041), and systemic chemotherapy after brain metastases (RR = 1.871, 95% CI 1.353–2.586, P < 0.001) were independent factors associated with survival. Conclusion Although survival of breast cancer patients with brain metastases was generally short, the performance status, number of brain metastases, treatment modalities and systemic chemotherapy after brain metastases were significantly associated with survival. Patients with single-brain metastasis and good performance status deserve aggressive treatment. The characteristics of initial primary breast lesions did not affect survival after brain metastasis.

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References

  1. Lee Y-T (1983) Breast carcinoma: pattern of metastasis at autopsy. J Surg Oncol 23:175–180

    Article  PubMed  CAS  Google Scholar 

  2. DiStefano A, Yap HY, Hortobagyi GN et al (1979) The natural history of breast cancer patients with brain metastases. Cancer 44:1913–1918

    Article  PubMed  CAS  Google Scholar 

  3. Bendell JC, Domchek SM, Burstein HJ et al (2003) Central nervous system metastases in women who receive trastuzumab-based therapy for metastatic breast carcinoma. Cancer 97:2972–2977

    Article  PubMed  Google Scholar 

  4. Shmueli E, Wigler N, Inbar M (2004) Central nervous system progression among patients with metastatic breast cancer responding to trastuzumab treatment. Eur J Cancer 40:379–382

    Article  PubMed  CAS  Google Scholar 

  5. Lower EE, Drosick DR, Blau R et al (2003) Increased rate of brain metastasis with trastuzumab therapy not associated with impaired survival. Clin Breast Cancer 4:114–119

    PubMed  CAS  Google Scholar 

  6. Clayton AJ, Danson S, Jolly S et al (2004) Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer. Br J Cancer 91:639–643

    PubMed  CAS  Google Scholar 

  7. Crivellari D, Pagani O, Veronesi A et al (2001) High incidence of central nervous system involvement in patients with metastatic or locally advanced breast cancer treated with epirubicin and docetaxel. Ann Oncol 12:353–356

    Article  PubMed  CAS  Google Scholar 

  8. Kosmas C, Malamos NA, Tsavaris NB et al (2002) Leptomeningeal carcinomatosis after major remission to taxane-based front line therapy in patients with advanced breast cancer. J Neurooncol 56:265–273

    Article  PubMed  Google Scholar 

  9. Chock J, Domchek S, Burstein H et al (2002) Central nervous system (CNS) metastases in women who receive trastuzumab for metastatic breast cancer (MBC) [abstract]. Proc Am Soc Clin Oncol 21:55a

    Google Scholar 

  10. Chang EL, Lo S (2003) Diagnosis and management of central nervous system metastases from breast cancer. Oncologist 8:398–410

    Article  PubMed  Google Scholar 

  11. Coia LR (1992) The role of radiation therapy in the treatment of brain metastases. Int J Radiat Oncol Biol Phys 23:229–238

    PubMed  CAS  Google Scholar 

  12. Gutin PH (1975) Corticosteroid therapy in patients with cerebral tumors: benefits, mechanisms, problems, practicalities. Semin Oncol 2:49–56

    PubMed  CAS  Google Scholar 

  13. Posner J (1977) Management of central nervous system metastases. Semin Oncol 4:81–91

    PubMed  CAS  Google Scholar 

  14. Pladdet I, Boven E, Nauta J et al (1989) Palliative care for brain metastases of solid tumour types. Neth J Med 34:10–21

    PubMed  CAS  Google Scholar 

  15. Cairncross JG, Kim J-H, Posner JB (1980) Radiation therapy for brain metastases. Ann Neurol 7:529–541

    Article  PubMed  CAS  Google Scholar 

  16. Mahmoud-Ahmed AS, Suh JH, Lee SY et al (2002) Results of whole brain radiotherapy in patients with brain metastases from breast cancer: a retrospective study. Int J Radiat Oncol Biol Phys 54:810–817

    PubMed  Google Scholar 

  17. Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain [see comments]. N Engl J Med 322:494–500

    Article  PubMed  CAS  Google Scholar 

  18. Ahn SH, Yoo KY, The Korean Breast Cancer Society (2006) Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996–2004. Breast Cancer Res Treat 99:209–214

    Article  PubMed  Google Scholar 

  19. Son BH, Kwak BS, Kim JK et al (2006) Changing patterns in the clinical characteristics of Korean patients with breast cancer during the last 15 years. Arch Surg 141:155–160

    Article  PubMed  Google Scholar 

  20. Tsukada Y, Fouad A, Pickren JW, Lane WW (1983) Central nervous system metastases from breast carcinoma: autopsy study. Cancer 52:2349–2354

    Article  PubMed  CAS  Google Scholar 

  21. Boogerd W, Vos VW, Hart AAM et al (1993) Brain metastases in breast cancer; natural history, prognostic factors, and outcome. J Neurooncol 15:165–174

    Article  PubMed  CAS  Google Scholar 

  22. Maki DD, Grossman RI (2000) Patterns of disease spread in metastatic breast carcinoma: influence of estrogen and progesterone receptor status. Am J Neuroradiol 21:1064–1066

    PubMed  CAS  Google Scholar 

  23. Higashi H, Fukutomi T, Watanabe T et al (2000) Seven cases of breast cancer recurrence limited to the central nervous system without other visceral metastases. Breast Cancer 7:153–156

    Article  PubMed  CAS  Google Scholar 

  24. Samaan NA, Buzdar AU, Aldinger KA et al (1981) Estrogen receptor: a prognostic factor in breast cancer. Cancer 47:554–560

    Article  PubMed  CAS  Google Scholar 

  25. Tham Y-L, Sexton K, Kramer R et al (2006) Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer 107:696–704

    Article  PubMed  Google Scholar 

  26. Lentzsch S, Reichardt P, Weber F et al (1999) Brain metastases in breast cancer: prognostic factors and management. Eur J Cancer 35:580–585

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Woo Kun Kim.

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Lee, S.S., Ahn, JH., Kim, M.K. et al. Brain metastases in breast cancer: prognostic factors and management. Breast Cancer Res Treat 111, 523–530 (2008). https://doi.org/10.1007/s10549-007-9806-2

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  • DOI: https://doi.org/10.1007/s10549-007-9806-2

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