J Breast Cancer.  2015 Mar;18(1):29-35. 10.4048/jbc.2015.18.1.29.

Local Control of Brain Metastasis: Treatment Outcome of Focal Brain Treatments in Relation to Subtypes

• Chong JU
• Ahn SG
• Lee HM
• Park JT
• Lee SA
• Park S
• Jeong J
• Kim SI

• KMID: 2286334
• DOI: http://doi.org/10.4048/jbc.2015.18.1.29

Abstract

PURPOSE
To investigate treatment options for local control of metastasis in the brain, we compared focal brain treatment (FBT) with or without whole brain radiotherapy (WBRT) vs. WBRT alone, for breast cancer patients with tumor relapse in the brain. We also evaluated treatment outcomes according to the subtypes.
METHODS
We conducted a retrospective review of breast cancer patients with brain metastasis after primary surgery. All patients received at least one local treatment for brain metastasis. Surgery or stereotactic radiosurgery was categorized as FBT. Patients were divided into two groups: the FBT group received FBT+/-WBRT, whereas the non-FBT group received WBRT alone. Subtypes were defined as follows: hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HR-positive/HER2-positive, HR-negative/HER2-positive, and triple-negative (TN). We examined the overall survival after brain metastasis (OSBM), brain metastasis-specific survival (BMSS), and brain metastasis-specific progression-free survival (BMPFS).
RESULTS
A total of 116 patients were identified. After a median follow-up of 50.9 months, the median OSBM was 11.5 months (95% confidence interval, 9.0-14.1 months). The FBT group showed significantly superior OSBM and BMSS. However, FBT was not an independent prognostic factor for OSBM and BMSS on multivariate analyses. In contrast, multivariate analyses showed that patients who underwent surgery had improved BMPFS, indicating local control of metastasis in the brain. FBT resulted in better BMPFS in patients with HR-negative/HER2-positive cancer or the TN subtype.
CONCLUSION
We found that patients who underwent surgery experienced improved local control of brain metastasis, regardless of its extent. Furthermore, FBT showed positive results and could be considered for better local control of brain metastasis in patients with aggressive subtypes such as HER2-positive and TN.

Keyword

Brain; Breast neoplasms; Cranial irradiation; Neoplasm metastasis; Radiosurgery; Surgery

MeSH Terms

Brain*
Breast Neoplasms
Cranial Irradiation
Disease-Free Survival
Follow-Up Studies
Humans
Multivariate Analysis
Neoplasm Metastasis*
Radiosurgery
Radiotherapy
Receptor, Epidermal Growth Factor
Recurrence
Retrospective Studies
Treatment Outcome*
Receptor, Epidermal Growth Factor

Figure

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  Figure 1 Consort diagrams. SRS=stereotactic radiosurgery; WBRT=whole brain radiotherapy.

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  Figure 2 Kaplan-Meier plots showing overall survival after brain metastasis and brain metastasis-specific progression-free survival for local treatment. All p-values were obtained by the log-rank test. (A) FBT vs. non-FBT, p<0.001. (B) Surgery vs. SRS vs. Surgery and SRS vs. WBRT alone, p=0.003. (C) FBT vs. non-FBT, p=0.152. (D) Surgery vs. SRS vs. Surgery and SRS vs. WBRT alone, p=0.001. FBT=focal brain treatment; SRS=stereotactic radiosurgery; WBRT=whole brain radiotherapy.

• 

  Figure 3 Kaplan-Meier plots showing brain metastasis-specific progression-free survival for local treatment, subdivided by subtype. All p-values were obtained by the log-rank test. (A) HR+HER2-, p=0.143. (B) HR+HER2+, p=0.515. (C) HR-HER2+, p=0.025. (D) Triple-negative, p=0.001. HR=hormone receptor; HER2=human epidermal growth factor receptor 2; FBT=focal brain treatment; TNBC=triple-negative breast cancer.

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