Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Gamma Knife Radiosurgery for Brain Metastases from Breast Cancer

  • Jo, Kyung Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Im, Young-Hyuck (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kong, Doo Sik (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seol, Ho Jun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Do-Hyun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung-Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2012.11.19
  • Accepted : 2013.11.11
  • Published : 2013.11.28
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Abstract

Objective : The authors conducted a retrospective cohort study to determine prognostic factors and treatment outcomes of brain metastases (BM) from breast cancer (BC) after Gamma Knife radiosurgery (GKS). Methods : Pathologic and clinical features, and outcomes were analyzed in a cohort of 62 patients with BM from BC treated by GKS. The Kaplan- Meier method, the log-rank test, and Cox's proportional hazards model were used to assess prognostic factors. Results : Median survival after GKS was 73.0 weeks (95% confidence interval, 46.0-100.1). HER2+ [hazard ratio (HR) 0.441; p=0.045], Karnofsky performance scale (KPS) ${\geq}70$ (RR 0.416; p=0.050) and systemic chemotherapy after GKS (RR 0.282; p=0.001) were found to be a favorable prognostic factor of overall survival. Actuarial local control (LC) rate were $89.5{\pm}4.5%$ and $70.5{\pm}6.9%$ at 6 and 12 months after GKS, respectively. No prognostic factors were found to affect LC rate. Uni- and multivariate analysis revealed that the distant control (DC) rate was higher in patients with; a small number (${\leq}3$) of metastasis (HR 0.300; p=0.045), no known extracranial metastasis (p=0.013, log-rank test), or the HER2+ subtype (HR 0.267; p=0.027). Additional whole brain radiation therapy and metastasis volume were not found to be significantly associated with LC, DC, or overall survival. Conclusion : The treatment outcomes of patients with newly diagnosed BM from BC treated with GKS could be affected primarily by intrinsic subtype, KPS, and systemic chemotherapy. Therapeutic strategy and prognosis scoring system should be individualized based on considerations of intrinsic subtype in addition to traditionally known parameters related to stereotactic radiosurgery.

Keywords

References

  1. Aoyama H : Radiation therapy for brain metastases in breast cancer patients. Breast Cancer 18 : 244-251, 2011 https://doi.org/10.1007/s12282-010-0207-8
  2. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al. : Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation : a randomised controlled trial. Lancet Oncol 10 : 1037-1044, 2009 https://doi.org/10.1016/S1470-2045(09)70263-3
  3. Duchnowska R, Dziadziuszko R, Czartoryska-Arlukowicz B, Radecka B, Szostakiewicz B, Sosinska-Mielcarek K, et al. : Risk factors for brain relapse in HER2-positive metastatic breast cancer patients. Breast Cancer Res Treat 117 : 297-303, 2009 https://doi.org/10.1007/s10549-008-0275-z
  4. Eichler AF, Kuter I, Ryan P, Schapira L, Younger J, Henson JW : Survival in patients with brain metastases from breast cancer : the importance of HER-2 status. Cancer 112 : 2359-2367, 2008 https://doi.org/10.1002/cncr.23468
  5. Gabos Z, Sinha R, Hanson J, Chauhan N, Hugh J, Mackey JR, et al. : Prognostic significance of human epidermal growth factor receptor positivity for the development of brain metastasis after newly diagnosed breast cancer. J Clin Oncol 24 : 5658-5663, 2006 https://doi.org/10.1200/JCO.2006.07.0250
  6. Golden DW, Lamborn KR, McDermott MW, Kunwar S, Wara WM, Nakamura JL, et al. : Prognostic factors and grading systems for overall survival in patients treated with radiosurgery for brain metastases : variation by primary site. J Neurosurg 109 Suppl : 77-86, 2008 https://doi.org/10.3171/JNS/2008/109/7/0077
  7. Goyal S, Prasad D, Harrell F Jr, Matsumoto J, Rich T, Steiner L : Gamma knife surgery for the treatment of intracranial metastases from breast cancer. J Neurosurg 103 : 218-223, 2005 https://doi.org/10.3171/jns.2005.103.2.0218
  8. Gu HW, Sohn MJ, Lee DJ, Lee HR, Lee CH, Whang CJ : Clinical analysis of novalis stereotactic radiosurgery for brain metastases. J Korean Neurosurg Soc 46 : 245-251, 2009 https://doi.org/10.3340/jkns.2009.46.3.245
  9. Le Scodan R, Massard C, Mouret-Fourme E, Guinebretierre JM, Cohen- Solal C, De Lalande B, et al. : Brain metastases from breast carcinoma : validation of the radiation therapy oncology group recursive partitioning analysis classification and proposition of a new prognostic score. Int J Radiat Oncol Biol Phys 69 : 839-845, 2007 https://doi.org/10.1016/j.ijrobp.2007.04.024
  10. Lee S, Ahn HK, Park YH, Nam do H, Lee JI, Park W, et al. : Leptomeningeal metastases from breast cancer : intrinsic subtypes may affect unique clinical manifestations. Breast Cancer Res Treat 129 : 809-817, 2011 https://doi.org/10.1007/s10549-011-1682-0
  11. Liu MT, Hsieh CY, Wang AY, Chang TH, Pi CP, Huang CC, et al. : Prognostic factors affecting the outcome of brain metastases from breast cancer. Support Care Cancer 14 : 936-942, 2006 https://doi.org/10.1007/s00520-006-0029-6
  12. Matsumoto K, Ando M, Yamauchi C, Egawa C, Hamamoto Y, Kataoka M, et al. : Questionnaire survey of treatment choice for breast cancer patients with brain metastasis in Japan : results of a nationwide survey by the task force of the Japanese Breast Cancer Society. Jpn J Clin Oncol 39 : 22-26, 2009
  13. Monje ML, Palmer T : Radiation injury and neurogenesis. Curr Opin Neurol 16 : 129-134, 2003 https://doi.org/10.1097/00019052-200304000-00002
  14. Nieder C, Marienhagen K, Astner ST, Molls M : Prognostic scores in brain metastases from breast cancer. BMC Cancer 9 : 105, 2009 https://doi.org/10.1186/1471-2407-9-105
  15. Ono M, Ando M, Yunokawa M, Nakano E, Yonemori K, Matsumoto K, et al. : Brain metastases in patients who receive trastuzumab-containing chemotherapy for HER2-overexpressing metastatic breast cancer. Int J Clin Oncol 14 : 48-52, 2009 https://doi.org/10.1007/s10147-008-0797-8
  16. Park IH, Ro J, Lee KS, Nam BH, Kwon Y, Shin KH : Trastuzumab treatment beyond brain progression in HER2-positive metastatic breast cancer. Ann Oncol 20 : 56-62, 2009
  17. Park YH, Park MJ, Ji SH, Yi SY, Lim DH, Nam DH, et al. : Trastuzumab treatment improves brain metastasis outcomes through control and durable prolongation of systemic extracranial disease in HER2-overexpressing breast cancer patients. Br J Cancer 100 : 894-900, 2009 https://doi.org/10.1038/sj.bjc.6604941
  18. Siu TL, Jeffree RL, Fuller JW : Current strategies in the surgical management of cerebral metastases : an evidence-based review. J Clin Neurosci 18 : 1429-1434, 2011 https://doi.org/10.1016/j.jocn.2011.04.002
  19. Tsukada Y, Fouad A, Pickren JW, Lane WW : Central nervous system metastasis from breast carcinoma. Autopsy study. Cancer 52 : 2349- 2354, 1983 https://doi.org/10.1002/1097-0142(19831215)52:12<2349::AID-CNCR2820521231>3.0.CO;2-B
  20. Wolstenholme V, Hawkins M, Ashley S, Tait D, Ross G : HER2 significance and treatment outcomes after radiotherapy for brain metastases in breast cancer patients. Breast 17 : 661-665, 2008 https://doi.org/10.1016/j.breast.2008.04.006

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