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Radiation therapy in the management of breast cancer brain metastases: the impact of receptor status on treatment response, intracranial recurrence, and survival

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Breast cancer is the second most common cancer to metastasize in the brain. Little is known about how receptor subtype, including luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) enriched, and triple negative (TN) affect response to radiation and distant intracranial recurrence (ICR) following radiation therapy.

Methods

We conducted a single-institution retrospective analysis of 38 breast cancer brain metastasis (BCBM) patients who underwent 93 treatment courses of stereotactic radiosurgery, stereotactic radiotherapy, post-operative radiation, or whole brain radiation therapy. Endpoints included overall survival (OS), treatment response (partial/complete response, PR/CR, or progression), ICR after treatment, and time from breast cancer diagnosis to the first BCBM (time to metastasis, TTM). Subset analyses were performed for triple receptor subtype as well as estrogen receptor (ER) positive versus negative, HER2+ versus HER2-, and age ≤ 50 versus >50 years old.

Results

Median OS for the population was 22.5 months, with median follow-up after treatment of 20.5 months. TTM was shortest for HER2 enriched, TN, ER−, and younger patients. TN, HER2-, and younger patients showed the poorest OS. ICR was also greatest in TN and HER2− patients. Radiation failure at the treated BCBM was seen most prominently in HER2+ and ER− patients.

Conclusion

Receptor subtypes that demonstrated poorer OS tended to demonstrate higher intracranial recurrence. A positive response to radiation was not associated with better OS or lower ICR. Identifying patterns based on receptor subtype may guide clinicians in management and surveillance for BCBM.

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Authors and Affiliations

  1. David Geffen School of Medicine, University of California Los Angeles, 10833 LeConte Ave #12138, Los Angeles, CA, 90095, USA

    Rebecca Levin-Epstein

  2. Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, CA, USA

    Pin-Chieh Wang, Stephen Tenn, Michael Selch, Antonio De Salles, Susan McCloskey, Patrick Kupelian, Michael Steinberg, Phillip Beron & Tania Kaprealian

  3. Department of Neurosurgery, University of California Los Angeles, 300 Stein Plaza Driveway #420, Los Angeles, CA, 90095, USA

    Nader Pouratian & Isaac Yang

Authors
  1. Rebecca Levin-Epstein
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  2. Pin-Chieh Wang
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  3. Stephen Tenn
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  4. Michael Selch
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  7. Susan McCloskey
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  12. Tania Kaprealian
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Corresponding author

Correspondence to Tania Kaprealian.

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Funding

No funding support is associated with this study.

Conflict of interest

Rebecca Levin-Epstein declares no conflict of interest. Pin-Chieh Wang declares no conflict of interest. Stephen Tenn declares no conflict of interest. Antonio de Salles declares no conflict of interest. Nader Pouratian declares no conflict of interest. Susan McCloskey declares no conflict of interest. Patrick Kupelian declares no conflict of interest. Michael Steinberg declares no conflict of interest. Phillip Beron declares no conflict of interest. Tania Kaprealian declares no conflicts of interest. Michael Selch is a member of the speakers bureau for BrainLab and receives a speaking fee for lectures. Isaac Yang receives consultant fees from BrainLab.

Ethical approval

IRB approval was obtained for this retrospective study. This article does not contain any studies with human or animal subjects performed by any of the authors.

Informed consent

For this type of retrospective study, formal consent is not required.

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Levin-Epstein, R., Wang, PC., Tenn, S. et al. Radiation therapy in the management of breast cancer brain metastases: the impact of receptor status on treatment response, intracranial recurrence, and survival. J Radiat Oncol 5, 401–409 (2016). https://doi.org/10.1007/s13566-016-0275-2

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  • DOI: https://doi.org/10.1007/s13566-016-0275-2

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