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Michel A, Darkwah Oppong M, Rauschenbach L, Dinger TF, Barthel L, Pierscianek D, Wrede KH, Hense J, Pöttgen C, Junker A, Schmidt T, Iannaccone A, Kimmig R, Sure U, Jabbarli R. Prediction of Short and Long Survival after Surgery for Breast Cancer Brain Metastases. Cancers (Basel) 2022; 14:cancers14061437. [PMID: 35326590 PMCID: PMC8946189 DOI: 10.3390/cancers14061437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 12/09/2022] Open
Abstract
Background: Brain metastases requiring surgical treatment determine the prognosis of patients with breast cancer. We aimed to develop the scores for the prediction of short (<6 months) and long (≥3 years) survival after BCBM surgery. Methods: Female patients with BCBM surgery between 2008 and 2019 were included. The new scores were constructed upon independent predictors for short and long postoperative survival. Results: In the final cohort (n = 95), 18 (18.9%) and 22 (23.2%) patients experienced short and long postoperative survival, respectively. Breast-preserving surgery, presence of multiple brain metastases and age ≥ 65 years at breast cancer diagnosis were identified as independent predictors of short postoperative survival. In turn, positive HER2 receptor status in brain metastases, time interval ≥ 3 years between breast cancer and brain metastases diagnosis and KPS ≥ 90% independently predicted long survival. The appropriate short and long survival scores showed higher diagnostic accuracy for the prediction of short (AUC = 0.773) and long (AUC = 0.775) survival than the breast Graded Prognostic Assessment score (AUC = 0.498/0.615). A cumulative survival score (total score) showed significant association with overall survival (p = 0.001). Conclusion: We identified predictors independently impacting the prognosis after BCBM surgery. After external validation, the presented scores might become useful tools for the selection of proper candidates for BCBM surgery.
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Affiliation(s)
- Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
- Correspondence: ; Tel.: +49-201-723-1230; Fax: +49-201-723-1220
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Lennart Barthel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Jörg Hense
- Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany;
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, 45147 Essen, Germany;
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, 45147 Essen, Germany;
| | - Teresa Schmidt
- Department of Neurooncology, University Hospital Essen, 45147 Essen, Germany;
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany; (A.I.); (R.K.)
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany; (A.I.); (R.K.)
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
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Pojskic M, Bopp MHA, Schymalla M, Nimsky C, Carl B. Retrospective study of 229 surgically treated patients with brain metastases: Prognostic factors, outcome and comparison of recursive partitioning analysis and diagnosis-specific graded prognostic assessment. Surg Neurol Int 2017; 8:259. [PMID: 29184710 PMCID: PMC5680662 DOI: 10.4103/sni.sni_228_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/26/2017] [Indexed: 01/18/2023] Open
Abstract
Background: Metastases are the most frequent tumors in the brain. Most often used scoring systems to predict the outcome are the RPA (Recursive Partitioning Analysis) classification and the DS-GPA (Diagnosis-Specific Graded Prognostic Assessment) score. The goal of our study was to determine prognostic factors which influence outcome in patients who undergo surgery for brain metastases and to compare different outcome scores. Methods: Two hundred and twenty-nine patients who underwent surgery for brain metastases in our institution between January 2005 and December 2014 were included in the study. Patient data were evaluated retrospectively. Results: The mean survival time was 19.2 months (median survival time, MST: 8 months), for patients with a single metastasis (n = 149) 17.6 months (MST: 8 months), and for patients with multiple metastases (n = 80) 17.9 months (MST: 6 months). Significant influence on MST had age <65 years (9 vs. 5 months, P = 0.002), female sex (10 vs. 6 months, P < 0.001), RPA Class I and II (11 vs. 4 months, P < 0.001), Karnofsky score >70% (11 vs. 4 months, P < 0.001), and postoperative radiotherapy (8 vs. 5 months, P < 0.002). To evaluate the diagnostic power of DS-GPA and RPA score in respect of survival, two Cox regressions were modeled, where the RPA classification showed a better predictive power. Conclusion: Favorable factors for prolonged survival were KPS >70%, RPA Class I and II, age <65 years, female sex, a DS-GPA Score of 2.5–3 and 3.5–4, and adjuvant radiotherapy. The RPA Classification was more accurate in predicting the outcome than the DS-GPA score.
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Affiliation(s)
- Mirza Pojskic
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Miriam H A Bopp
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Markus Schymalla
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Barbara Carl
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
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3
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Liu Z, Lei B, Zheng M, Li Z, Huang S, Deng Y. Prognostic factors in patients treated with surgery for brain metastases: A single-center retrospective analysis of 125 patients. Int J Surg 2017; 44:204-209. [PMID: 28528216 DOI: 10.1016/j.ijsu.2017.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/11/2017] [Accepted: 05/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUD Brain metastases are the most common malignant intracranial tumors, however, the prognosis of patients is still poor despite multiple treatment have been applicated. The aim of this study was to analyse parameters influence overall survival from patient, tumor and treatment. Summarized characteristics of long-time (>2 years) survivors furtherly. MATERIALS AND METHODS In total, clinical data of 125patients between 2004 and 2015 were collected and the parameters from patients, tumor and treatment were evaluated. Univariate analysis was performed using Kaplan-Meier and Log-rank test, multivariate analysis was performed using Cox proportional hazards regression model, respectively. RESULTS Median overall survival time was 14.5 (95% confidence interval were 12.3-16.7) months and median survival time was 34.5 (95% confidence interval were 30.1-38.9) months in long-time survivors, respectively.KPS, RPA, GPA, number of brain metastases, extracranial metastases, treatment pattern and resection method were identified influence survival time significantly by univariate analysis. KPS, number of brain metastases, extracranial metastases and treatment pattern were independent prognosis factors by multivariate analysis. Long-time survivors obtain higher KPS, complete resection, adjuvant therapy postoperative more commonly. CONCLUSION Higher KPS, GPA I,RPA3.5∼4, single brain metastases, adjuvant therapy postoperative and complete resection were significant improve survival time, however, extracranial metastases significant decreased survival time. Patients who have good status and received multimodality therapy involved complete resection can survive longer time more commonly.
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Affiliation(s)
- Zhenghao Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bingxi Lei
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meiguang Zheng
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongjun Li
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuaibin Huang
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuefei Deng
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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[Imaging methods used in the differential diagnosis between brain tumour relapse and radiation necrosis after stereotactic radiosurgery of brain metastases: Literature review]. Cancer Radiother 2016; 20:837-845. [PMID: 28270324 DOI: 10.1016/j.canrad.2016.07.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
After stereotactic radiosurgery for a cerebral metastasis, one of the dreaded toxicities is radionecrosis. In the follow-up of these patients, it is impossible to distinguish radiation necrosis from tumour relapse either clinically or with MRI. In current practice, many imaging methods are designed such as special sequences of MRI (dynamic susceptibility contrast perfusion and susceptibility-weighted imaging, diffusion), proton magnetic resonance spectroscopy, positron emission tomography, or more seldom 201-thallium single-photon emission computerized tomography. This article is a required literature analysis in order to establish a decision tree with the analysis of retrospective and prospective data.
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Martínez-Aranda A, Hernández V, Guney E, Muixí L, Foj R, Baixeras N, Cuadras D, Moreno V, Urruticoechea A, Gil M, Oliva B, Moreno F, González-Suarez E, Vidal N, Andreu X, Seguí MA, Ballester R, Castella E, Sierra A. FN14 and GRP94 expression are prognostic/predictive biomarkers of brain metastasis outcome that open up new therapeutic strategies. Oncotarget 2015; 6:44254-73. [PMID: 26497551 PMCID: PMC4792555 DOI: 10.18632/oncotarget.5471] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022] Open
Abstract
Brain metastasis is a devastating problem in patients with breast, lung and melanoma tumors. GRP94 and FN14 are predictive biomarkers over-expressed in primary breast carcinomas that metastasized in brain. To further validate these brain metastasis biomarkers, we performed a multicenter study including 318 patients with breast carcinomas. Among these patients, there were 138 patients with metastasis, of whom 84 had brain metastasis. The likelihood of developing brain metastasis increased by 5.24-fold (95%CI 2.83-9.71) and 2.55- (95%CI 1.52-4.3) in the presence of FN14 and GRP94, respectively. Moreover, FN14 was more sensitive than ErbB2 (38.27 vs. 24.68) with similar specificity (89.43 vs. 89.55) to predict brain metastasis and had identical prognostic value than triple negative patients (p < 0.0001). Furthermore, we used GRP94 and FN14 pathways and GUILD, a network-based disease-gene prioritization program, to pinpoint the genes likely to be therapeutic targets, which resulted in FN14 as the main modulator and thalidomide as the best scored drug. The treatment of mice with brain metastasis improves survival decreasing reactive astrocytes and angiogenesis, and down-regulate FN14 and its ligand TWEAK. In conclusion our results indicate that FN14 and GRP94 are prediction/prognosis markers which open up new possibilities for preventing/treating brain metastasis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angiogenesis Inhibitors/therapeutic use
- Animals
- Area Under Curve
- Astrocytes/drug effects
- Astrocytes/metabolism
- Astrocytes/pathology
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Brain Neoplasms/drug therapy
- Brain Neoplasms/genetics
- Brain Neoplasms/metabolism
- Brain Neoplasms/secondary
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/secondary
- Cell Line, Tumor
- Cytokine TWEAK
- Female
- Humans
- Immunohistochemistry
- Likelihood Functions
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/metabolism
- Mice, Nude
- Middle Aged
- Precision Medicine
- Predictive Value of Tests
- Prognosis
- ROC Curve
- Receptors, Tumor Necrosis Factor/genetics
- Receptors, Tumor Necrosis Factor/metabolism
- Risk Assessment
- Risk Factors
- Spain
- TWEAK Receptor
- Thalidomide/therapeutic use
- Tissue Array Analysis
- Tumor Microenvironment
- Tumor Necrosis Factors/metabolism
- Xenograft Model Antitumor Assays
- Young Adult
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Affiliation(s)
- Antonio Martínez-Aranda
- Biological Clues of the Invasive and Metastatic Phenotype Group, Molecular Oncology Department, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Biochemistry and Molecular Biology Department, Faculty of Biosciences, Campus Bellaterra, Edifici C, Cerdanyola del Vallés, 08193 Barcelona, Spain
| | - Vanessa Hernández
- Biological Clues of the Invasive and Metastatic Phenotype Group, Molecular Oncology Department, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emre Guney
- Structural Bioinformatics Laboratory, Experimental Sciences Department, Universitat Pompeu Fabra-IMIM, Barcelona Research Park of Biomedicine, 08003 Barcelona, Spain
| | - Laia Muixí
- Biological Clues of the Invasive and Metastatic Phenotype Group, Molecular Oncology Department, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ruben Foj
- Biological Clues of the Invasive and Metastatic Phenotype Group, Molecular Oncology Department, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Biochemistry and Molecular Biology Department, Faculty of Biosciences, Campus Bellaterra, Edifici C, Cerdanyola del Vallés, 08193 Barcelona, Spain
| | - Núria Baixeras
- Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Cuadras
- Biomarkers and Susceptibility Unit, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Moreno
- Biomarkers and Susceptibility Unit, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ander Urruticoechea
- Breast Cancer Unit and Neuroncology Unit, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Gil
- Oncology Service, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Baldo Oliva
- Structural Bioinformatics Laboratory, Experimental Sciences Department, Universitat Pompeu Fabra-IMIM, Barcelona Research Park of Biomedicine, 08003 Barcelona, Spain
| | - Ferran Moreno
- Radiation Oncology Service, Institut Català d'Oncologia - IDIBELL, Hospital Duran i Reynals, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva González-Suarez
- Transformation and Metastasis Grup, Cancer Epigenetics and Biology Department, IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Noemí Vidal
- Servei d'Anatomia Patològica, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Andreu
- Pathology Service, Corporació Sanitaria Parc Taulí, 08208 Sabadell, Spain
| | - Miquel A. Seguí
- Oncology Service, Corporació Sanitaria Parc Taulí, 08208 Sabadell, Spain
| | - Rosa Ballester
- Radiation Oncology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Eva Castella
- Pathology Service, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Angels Sierra
- Biological Clues of the Invasive and Metastatic Phenotype Group, Molecular Oncology Department, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Molecular and Translational Oncology Laboratory, Biomedical Research Center CELLEX-CRBC Institut d'Investigacions Biomèdiques August Pi i Sunyer-IDIBAPS 08036 Barcelona, Spain
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Radiothérapie encéphalique en totalité des métastases cérébrales : intérêts et controverses dans le cadre d’un référentiel. Cancer Radiother 2015; 19:30-5. [DOI: 10.1016/j.canrad.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 11/18/2022]
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3D radiation therapy boost improves the outcome of whole brain radiation therapy treated RPA II patients with one or two brain metastases. Int J Mol Sci 2014; 15:7554-62. [PMID: 24798750 PMCID: PMC4057690 DOI: 10.3390/ijms15057554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/07/2014] [Accepted: 04/24/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose to evaluate the role of whole brain radiotherapy (WBRT) and radiation boost (RB) for 208 patients recursive partitioning analysis (RPA) II with 1 or 2 brain metastases (BM) at a single institution. Methods and Materials the dose of WBRT was 30 Gy (10 fractions of 3 Gy). One hundred thirty-two patients (63.5%) benefited from RB of 9 Gy in 3 fractions of 3 Gy at the metastatic site. Patients had 1 or 2 BM in 122 (58.7%) and 86 cases (41.3%), respectively. Results patients with one or two metastases had similar survival (4.6 and 5.1 months, respectively) (p = 0.4). Median overall survival (OS) for patients treated with WBRT and RB, and with WBRT alone was 5.9 and 3.7 months, respectively (p = 0.03). The 6-, 12- and 24-month OS rates after WBRT and RB were 48.5%, 25% and 10.6%, respectively, while WBRT alone resulted in OS rates of 34%, 22.4% and 3.2%, respectively (p = 0.03). After WBRT and RB, the 6-, 12- and 24-month local control rates were 92%, 82% and 67%, respectively, while they were 81.2%, 75% and 37.5%, respectively, after WBRT alone (p = 0.03). The 6-, 12- and 24-month brain control rates after WBRT and RB were 88.7%, 75.8% and 62%, respectively, and after WBRT alone they were 78.5%, 59% and 37.7%, respectively (p = 0.03). Conclusion additional boost delivered with 3D conformal radiotherapy improves local and brain control rates significantly as well as overall survival for RPA II patients with 1 or 2 unresectable BM.
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8
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Nagai A, Shibamoto Y, Yoshida M, Wakamatsu K, Kikuchi Y. Treatment of single or multiple brain metastases by hypofractionated stereotactic radiotherapy using helical tomotherapy. Int J Mol Sci 2014; 15:6910-24. [PMID: 24758932 PMCID: PMC4013669 DOI: 10.3390/ijms15046910] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 12/13/2022] Open
Abstract
This study investigated the clinical outcomes of a 4-fraction stereotactic radiotherapy (SRT) study using helical tomotherapy for brain metastases. Between August 2009 and June 2013, 54 patients with a total of 128 brain metastases underwent SRT using tomotherapy. A total dose of 28 or 28.8 Gy at 80% isodose was administered in 4 fractions for all tumors. The mean gross tumor volume (GTV) was 1.9 cc. Local control (LC) rates at 6, 12, and 18 months were 96%, 91%, and 88%, respectively. The 12-month LC rates for tumors with GTV ≤0.25, >0.25 and ≤1, and >1 cc were 98%, 82%, and 93%, respectively; the rates were 92% for tumors >3 cc and 100% for >10 cc. The 6-month rates for freedom from distant brain failure were 57%, 71%, and 55% for patients with 1, 2, and >3 brain metastases, respectively. No differences were significant. No major complications were observed. The 4-fraction SRT protocol provided excellent tumor control with minimal toxicity. Distant brain failure was not so frequent, even in patients with multiple tumors. The results of the current study warrant a prospective randomized study comparing single-fraction stereotactic radiosurgery (SRS) with SRT in this patient population.
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Affiliation(s)
- Aiko Nagai
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
| | - Masanori Yoshida
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Koichi Wakamatsu
- Department of Neurosurgery, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Yuzo Kikuchi
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
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9
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Feuvret L, Vinchon S, Martin V, Lamproglou I, Halley A, Calugaru V, Chea M, Valéry CA, Simon JM, Mazeron JJ. Stereotactic radiotherapy for large solitary brain metastases. Cancer Radiother 2014; 18:97-106. [PMID: 24439342 DOI: 10.1016/j.canrad.2013.12.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess effectiveness and toxicity levels of stereotactic radiation therapy without whole brain radiation therapy in patients with solitary brain metastases larger than 3cm. PATIENTS AND METHODS Between June 2007 and March 2009, 12 patients received fractionated stereotactic radiation therapy and 24 patients underwent stereotactic radiosurgery. For the fractionated stereotactic radiation therapy group, 3×7.7Gy were delivered to the planning target volume (PTV); median volume and diameter were 29.4 cm(3) and 4.4cm, respectively. For the stereotactic radiosurgery group, 14Gy were delivered to the PTV; median volume and diameter were 15.6 cm(3) and 3.7cm, respectively. RESULTS Median follow-up was 218 days. For the fractionated stereotactic radiation therapy group, local control rates were 100% at 360 days and 64% at 720 days; for the stereotactic radiosurgery group, rates were 58% at 360 days and 48% at 720 days (P=0.06). Median survival time was 504 days for the fractionated stereotactic radiation therapy group and 164 days for the stereotactic radiosurgery group (P=0.049). Two cases of grade 2 toxicity were observed in the fractionated stereotactic radiation therapy group, and 6 cases of grade 1-2 toxicity, in the stereotactic radiosurgery group. CONCLUSIONS This study provides data to support that fractionated stereotactic radiation therapy without whole brain radiation therapy with a margin dose of 3 fractions of 7.7Gy for treatment of solitary large brain metastases is efficient and well-tolerated. Because of the significant improvement in overall survival, this schedule should be assessed in a randomized trial.
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Affiliation(s)
- L Feuvret
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - S Vinchon
- Centre Paul-Papin, 2, rue Moll, 49100 Angers cedex, France
| | - V Martin
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - I Lamproglou
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - A Halley
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - V Calugaru
- Centre de protonthérapie d'Orsay (CPO), institut Curie, bâtiment 101, campus universitaire, 91898 Orsay cedex, France
| | - M Chea
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - C A Valéry
- Unité de Gamma-Knife, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J-M Simon
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J-J Mazeron
- Centre des tumeurs, groupe Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Tallet A. [Brain metastases from breast cancer]. Cancer Radiother 2013; 17:708-14. [PMID: 24210659 DOI: 10.1016/j.canrad.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/19/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Abstract
Breast cancer is the second leading cause of brain metastases and account for 15 % of metastatic breast cancer patients. Several patient- and tumor-related characteristics have been identified as risk factors for developing brain metastases. Treatment is based on local and/or systemic therapies, tailored to breast cancer brain metastases-specific prognostic factors. This article is an update on the current knowledge of the incidence, prognosis and prognostic factors, treatment and perspectives in brain metastases from breast cancer.
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Affiliation(s)
- A Tallet
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille cedex 09, France.
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