J Breast Cancer.  2011 Feb;14(Suppl 1):S57-S63. 10.4048/jbc.2011.14.S.S57.

Incidence of Brain Metastasis and Related Subtypes in Patients with Breast Cancer Receiving Adjuvant Radiation Therapy after Surgery

• Bae SH
• Choi DH
• Huh SJ
• Lim DH
• Park W
• Nam H
• Yang JH
• Nam SJ
• Lee JE
• Im YH
• Ahn JS
• Park YH

• KMID: 1340915
• DOI: http://doi.org/10.4048/jbc.2011.14.S.S57

Abstract

PURPOSE
To assess the incidence of brain metastasis in patients with breast cancer receiving surgery and adjuvant radiotherapy (RT) and to evaluate subtypes associated with brain metastasis.
METHODS
We retrospectively reviewed the medical records of 1,000 patients with breast cancer who were treated with surgery and adjuvant RT for a cure between January 2001 and July 2005 at Samsung Medical Center. Seventy-one patients received neoadjuvant chemotherapy before surgery. The pathological stage was I in 430 patients, II in 327, and III in 243. We divided the patients into three subtypes according to immunohistochemistry: triple negative (TN, 245 patients), human epidermal growth factor 2 (HER2) enriched (HE, 166 patients) and positive estrogen receptor or progesterone receptor without HER2 overexpression (EP, 589 patients). The median follow up time was 72 months after surgery.
RESULTS
Locoregional failure-free survival rate and distant metastasis-free survival rate at 5 years were 92.8% and 86.1%, respectively. The disease free survival rate and overall survival rate at 5 years were 84.6% and 94.7%, respectively. Thirty-nine patients had brain metastasis, and the brain metastasis-free survival rate at 5 years was 97.2%. A univariate analysis showed that younger age, neoadjuvant chemotherapy, modified radical mastectomy, advanced pathological stage and the TN and HE subtypes were significant risk factors for brain metastasis. A multivariate analysis revealed that age, neoadjuvant chemotherapy, pathological stage and the TN and HE subtypes were statistically significant factors for brain metastasis.
CONCLUSION
The cumulative incidence of brain metastasis was 3.9% after curative treatment. If patients have a clinically suspicious symptoms suggesting brain metastasis, clinicians should be aware that an early brain imaging work up and management are necessary. Because patients with the TN or HE subtypes accompanied by younger age and advanced pathological stage have increased brain metastasis (>10%), annual regular imaging follow-up may be recommended for these high risk patients.

Keyword

Breast neoplasms; Immunohistochemistry; Neoplasm metastasis; Brain; Radiotherapy

MeSH Terms

Humans
Incidence
Risk Factors
Neoplasm Metastasis
Breast Neoplasms

Figure

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  Figure 1 Cumulative incidence of brain metastasis.

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  Figure 2 Five-years brain metastasis (BM) free survival rate.

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  Figure 3 There was a statistically significant difference in brain metastasis (BM) free survival according to hormone subtype: 91.9% in HER2 enriched group, 95.2% in triple negative group and 99.4% in ER+/- PR positive without HER2 overexpression (p<0.0001). ER=estrogen receptor; PR=progesterone receptor.

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  Figure 4 There was a difference in brain metastasis (BM) free survival according to immunohistochemical subtypes (A) in patients with younger age (≤40 yr) and pathologic stage III (B) in patients with younger age (≤40 yr), pathologic stage III and neoadjuvant chemotherapy. ER=estrogen receptor; PR=progesterone receptor.

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