Cancer Res Treat.  2017 Jul;49(3):748-758. 10.4143/crt.2016.303.

Effects of Postoperative Radiotherapy on Leptomeningeal Carcinomatosis or Dural Metastasis after Resection of Brain Metastases in Breast Cancer Patients

• Ha B
• Chung SY
• Kim YJ
• Gwak HS
• Chang JH
• Lee SH
• Park IH
• Lee KS
• Lee S
• Kim TH
• Kim DY
• Kang SG
• Suh CO

• KMID: 2388320
• DOI: http://doi.org/10.4143/crt.2016.303

Abstract

PURPOSE
In this retrospective study, we compared the incidence of leptomeningeal carcinomatosis or dural metastasis (LMCDM) in patients who received whole brain radiotherapy (WBRT), partial radiotherapy (PRT), or no radiotherapy (RT) following resection of brain metastases from breast cancer.
MATERIALS AND METHODS
Fifty-one patients with breast cancer underwent surgical resection for newly diagnosed brain metastases in two institutions between March 2001 and March 2015. Among these, 34 received postoperative WBRT (n=24) or PRT (n=10) and 17 did not.
RESULTS
With a median follow-up of 12.4 months (range, 2.3 to 83.6 months), 22/51 patients developed LMCDM at a median of 8.6 months (range, 4.8 to 51.2 months) after surgery. The 18-months LMCDM-free survival (LMCDM-FS) rates were 77.5%, 30.0%, and 13.6%, in the WBRT, PRT, and no RT groups, respectively (p=0.013). The presence of a tumor adjacent to cerebrospinal fluid flow and no systemic treatment after treatment for brain metastases were also associated with poor LMCDM-FS rate. Multivariate analysis showed that WBRT compared to PRT (p=0.009) and systemic treatment (p < 0.001) were independently associated with reduced incidence of LMCDM.
CONCLUSION
WBRT improved LMCDM-FS rate after resection of brain metastases compared to PRT in breast cancer patients.

Keyword

Breast neoplasms; Meningeal carcinomatosis; Whole brain radiotherapy; Partial radiotherapy

MeSH Terms

Brain*
Breast Neoplasms*
Breast*
Cerebrospinal Fluid
Follow-Up Studies
Humans
Incidence
Meningeal Carcinomatosis*
Multivariate Analysis
Neoplasm Metastasis*
Radiotherapy*
Retrospective Studies

Figure

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  Fig. 1. (A-D) Gadolinum enhanced T1 weighted magnetic resonance imaging (MRI) image of a patient who developed multiple enhancing dural nodules 6 months after surgical resection for brain metastasis and postoperative partial radiotherapy to the tumor bed. Dural metastasis was defined as a presence of such multiple enhancing nodules on the dura mater on MRI.

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  Fig. 2. Intracranial recurrence rate and pattern of failures in three treatment groups: no radiotherapy (RT) group (n=17), partial RT (PRT) group (n=10), and whole brain radiotherapy (WBRT) group (n=24). LR, local recurrence; DBR, distant brain recurrence; LMCDM, leptomeningeal carcinomatosis or dural metastasis.

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  Fig. 3. Leptomeningeal carcinomatosis or dural metastasis–free survival (LMCDM-free survival) comparing three treatment groups (whole brain radiotherapy [WBRT] group [n=24], partial radiotherapy [PRT] group [n=10], and no radiotherapy [RT] group [n=17]) (A) and comparing two groups (WBRT [n=24] or not [n=27]) (B).

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  Fig. 4. Local recurrence–free survival for whole brain radiotherapy (WBRT) group (n=24), partial radiotherapy (PRT) group (n=10), and no radiotherapy (RT) group (n=17).

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  Fig. 5. Overall survival for whole brain radiotherapy (WBRT) group (n=24), partial radiotherapy (PRT) group (n=10), and no radiotherapy (RT) group (n=17).

Reference

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