Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer

Clinical article

Douglas Kondziolka M.D.1,2,4,5, Hideyuki Kano M.D., Ph.D.1,4, Gillian L. Harrison B.S.6, Huai-che Yang M.D.1,4,7, Donald N. Liew M.D.1,4, Ajay Niranjan M.Ch., M.B.A.1,4, Adam M. Brufsky M.D., Ph.D.3,5, John C. Flickinger M.D.2,4,6, and L. Dade Lunsford M.D.1,2,4,5
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  • 1 Departments of Neurological Surgery,
  • | 2 Radiation Oncology, and
  • | 3 Hematology/Oncology;
  • | 4 Center for Image-Guided Neurosurgery;
  • | 5 University of Pittsburgh Cancer Institute;
  • | 6 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
  • | 7 Department of Neurological Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan
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Object

To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival.

Methods

The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19–84 years), and the median number of tumors per patient was 2 (range 1–18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm3 (range 0.01–48.9 cm3), and the median total tumor volume for each patient was 4.9 cm3 (range 0.09–74.1 cm3).

Results

Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable.

Conclusions

Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.

Abbreviations used in this paper:

ARE = adverse radiation effect; EORTC = European Organisation for Research and Treatment of Cancer; GKS = Gamma Knife surgery; KPS = Karnofsky Performance Scale; MST = median survival time; OS = overall survival; PFS = progression-free survival; RPA = recursive partitioning analysis; RTOP = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy.

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