Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery Journal Article

Authors: Yang, T. J.; Oh, J. H.; Folkert, M. R.; Gupta, G.; Shi, W.; Zhang, Z.; Morikawa, A.; Seidman, A.; Brennan, C.; Yamada, Y.; Chan, T. A.; Beal, K.
Article Title: Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery
Abstract: Background: With the continuing increase in the use of definitive stereotactic radiosurgery(SRS) for patients with limited brain metastases (BM), clinicians need morespecific prognostic tools. We investigated clinical predictors of outcomes in patientswith limited breast cancer BM treated with SRS alone. Methods and Materials: We identified 136 patients with breast cancer and 1-3 BMwho underwent definitive SRS for 186 BM between 2000 and 2012. The Kaplan-Meier method was used to assess overall survival (OS), regional failure (RF), and localfailure (LF). Associations between clinical factors and outcomes were tested usingCox regression. A point scoring system was used to stratify patients based on OS,and the predictive power was tested with concordance probability estimate (CPE). Results: The median OS was 17.6 months. The 12-month RF and LF rates were 45%and 10%, respectively. On multivariate analysis, >1 lesion (hazard ratio [HR] = 1.6,P=.02), triple-negative (TN) disease (HR=2.0, P=.006), and active extracranialdisease (ED) (HR=2.7, P<.0001) were significantly associated with worse OS. Thepoint score system was defined using proportional simplification of the multivariateCox proportional hazards regression function. The median OS for patients with3.0-4.0 points (n=37), 4.5-5.5 points (n=28), 6.0-6.5 points (n=37), and 8-8.5 points(n=34) were 9.2, 15.6, 25.1, and 45.1 months, respectively (P<.0001, CPE = 0.72).Active ED (HR=2.4, PZ.0007) was significantly associated with RF. Higher risk forLF was significantly associated with larger BM size (HR=3.1, P=.0001). Conclusion: Patients with >1 BM, active ED, and TN had the highest risk of deathafter SRS. Active ED is an important prognostic factor for OS and intracranial control.
Keywords: adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; cancer surgery; treatment failure; major clinical study; overall survival; salvage therapy; treatment duration; cancer radiotherapy; cancer staging; nuclear magnetic resonance imaging; follow up; antineoplastic agent; computer assisted tomography; breast cancer; tumor volume; risk factor; contrast enhancement; prognostic factors; brain metastasis; contrast medium; stereotactic radiosurgery; radiation necrosis; computed tomography scanner; local failure; regional failure; oncological parameters; cancer prognosis; human; female; article
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 90
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2014-11-01
Start Page: 518
End Page: 525
Language: English
DOI: 10.1016/j.ijrobp.2014.06.063
PROVIDER: scopus
PUBMED: 25194669
PMCID: PMC5736317
Notes: Export Date: 1 December 2014 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    239 Zhang
  2. Timothy Chan
    209 Chan
  3. Andrew D Seidman
    241 Seidman
  4. Weiji Shi
    111 Shi
  5. Yoshiya Yamada
    353 Yamada
  6. Cameron Brennan
    149 Brennan
  7. Michael Ryan Folkert
    36 Folkert
  8. Kathryn Beal
    156 Beal
  9. Gaorav Gupta
    32 Gupta
  10. Jung Hun Oh
    110 Oh
  11. T. Jonathan Yang
    63 Yang
  12. Wei   Shi
    7 Shi