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Journal of Neuro-Oncology

, Volume 15, Issue 2, pp 165–174 | Cite as

Brain metastases in breast cancer; natural history, prognostic factors and outcome

  • W. Boogerd
  • V. W. Vos
  • A. A. M. Hart
  • G. Baris
Clinical Study

Summary

One hundred and thirty seven breast cancer patients with CT scan documented brain metastasis (BM) were reviewed. Occurrence of brain as first site of relapse was associated with adjuvant systemic therapy of the primary tumor. Multivariate analysis showed significantly longer survival in patients without manifest systemic disease, in patients with a solitary BM, in those with neurologic symptoms present for more than 4 weeks prior to diagnosis, and in those treated with chemotherapy after diagnosis. When controlling for prognostic factors no significant difference in survival was found between surgery and radiotherapy (RT) as treatment of a solitary lesion. Tumor size, tumor necrosis and mass effect had no demonstrable influence on survival. Overall median survival was 16 weeks and 19% survived one year. Neurologic disease was the cause of death or a major contributing factor to it in 68% of the patients, indicating the need for improvement of the treatment of BM itself. These results warrant further studies on the value of surgery, RT and chemotherapy in solitary as well as multiple BM from breast carcinoma.

Key words

breast cancer adjuvant chemotherapy brain metastasis tumor characteristics prognostic factors 

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References

  1. 1.
    Posner JB, Chernik NL: Intracranial metastases from systemic cancer. Adv Neurol 19: 579–592, 1978Google Scholar
  2. 2.
    Tsukada Y, Fouad A, Pickren JW, Lane WW: Central nervous system metastasis from breast carcinoma: Autopsy Study. Cancer 52: 2349–2354, 1983Google Scholar
  3. 3.
    Lee Y-TN: Patterns of metastasis and natural courses of breast carcinoma. Cancer Metast Rev 4:153–172, 1985Google Scholar
  4. 4.
    Di Stefano A, Yap HY, Hortobagyi GN, Blumenschein GR: The natural history of breast cancer patients with brain metastases. Cancer 44:1913–1918, 1979Google Scholar
  5. 5.
    Markesbery WR, Brooks WH, Gupta GD, Young AB: Treatment for patients with cerebral metastases. Arch Neurol 35: 754–756, 1978Google Scholar
  6. 6.
    West J, Maor M: Intracranial metastases, behavioral patterns related to primary site and results of treatment by whole brain irradiation. Int J Radiation Oncol Biol Phys 6: 11–15, 1980Google Scholar
  7. 7.
    Cairncross JG, Kim JH, Posner JB: Radiation therapy for brain metastases. Ann Neurol 7: 529–541, 1980Google Scholar
  8. 8.
    Hoskin PJ, Crow J, Ford HT: The influence of extent and local management on the outcome of radiotherapy for brain metastases. Int J Radiation Oncol Biol Phys 19:111–115, 1990Google Scholar
  9. 9.
    Patchell RA, Cirrincione C, Thaler HT, Galicich JH, Kim J, Posner JB: Single brain metastases: Surgery plus radiation or radiation alone. Neurology 36: 447–453, 1986Google Scholar
  10. 10.
    Posner JB, Shapiro WR: Brain tumor. Current status of treatment and its complications. Arch Neurol 32: 781–784, 1975Google Scholar
  11. 11.
    Borgelt B, Gelder R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR: The palliation of brain metastases: final results of the first two studies by the radiation therapy oncology group. Int J Radiation Oncol Biol Phys 6: 1–8, 1980Google Scholar
  12. 12.
    Cairncross JG, Chernik NL, Kim J, Posner JB: Sterilization of cerebral metastases by radiation therapy. Neurology 29: 1195–1202, 1979Google Scholar
  13. 13.
    Gelber RD, Larson M, Borgelt BB, Kramer S: Equivalence of radiation schedules for palliative treatment of brain metastasis in patients with favorable prognosis. Cancer 48: 1749–1753, 1981Google Scholar
  14. 14.
    Eyre HL, Ohlsen JD, Frank J, Lo Buglio AF, Mc Cracken JD, Weatherall TJ, Mansfield CM: Randomized trial of radiotherapy versus radiotherapy plus metronidazole for the treatment of metastatic cancer to the brain. J Neuro-Oncol 2: 325–330, 1984Google Scholar
  15. 15.
    De Angelis LM, Currie VE, Kim J, Krol G, Hehir MA, Farag FM, Young CW, Posner JB: The combined use of radiation therapy and lonidamine in the treatment of brain metastases. J Neuro-Oncol 7: 241–247, 1989Google Scholar
  16. 16.
    Kurtz JM, Gelber R, Brady LW, Carella RJ, Cooper JS: The palliation of brain metastases in a favorable patient population: A randomized clinical trial by the radiation therapy oncology group. Int J Radiat Oncol Biol Phys 7: 891–895, 1981Google Scholar
  17. 17.
    Zimm S, Wampler GL, Stablein D, Hazra T, Young HF: Intracerebral metastases in solid-tumor patients. Natural history and results of treatment. Cancer 48: 384–394, 1981Google Scholar
  18. 18.
    Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio R, Markesbery WR, Macdonald JS, Young B: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322: 494–500, 1990Google Scholar
  19. 19.
    Kristjansen PEG, Hansen HH: Brain metastases from small cell lung cancer treated with combination chemotherapy. Eur J Cancer Clin Oncol 24: 545–549, 1988Google Scholar
  20. 20.
    Rosner D, Nemoto T, Lane W: Chemotherapy induces regression of brain metastases in breast carcinoma. Cancer 58: 832–839, 1986Google Scholar
  21. 21.
    Cocconi G, Lottici R, Bisagni G, Bacchi M, Tonato M, Passalacqua R, Bonil C, Belsanti V, Bassi P: Combination therapy with platinum and etoposide of brain metastases from breast carcinoma. Cancer Inv 8: 327–334, 1990Google Scholar
  22. 22.
    Boogerd W, Dalesio O, Bais EM, Van der Sande JJ: Response of brain metastases from breast cancer to systemic chemotherapy. Cancer 69: 972–980, 1992Google Scholar
  23. 23.
    Kamby C, Soerensen PS: Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer. J Neuro Oncol 6: 37–45, 1988Google Scholar
  24. 24.
    Cox DR: Regression models and life-tables. JR Stat Soc 34: 187–220, 1972Google Scholar
  25. 25.
    Van Houwelingen JC, Le Cessie S: Predictive value of statistical models. Stat Med 9:1303–1325, 1990Google Scholar
  26. 26.
    Hietanen P, Miettinen M, Makinen J: Survival after first recurrence in breast cancer. Eur J Cancer Clin Oncol 22: 913–919, 1986Google Scholar
  27. 27.
    Clark GW, Sledge GW, Osborne CK, McGuire WL: Survival from first recurrence: relative importance of prognostic factors in 1015 breast cancer patients. J Clin Oncol 5: 55–61, 1987Google Scholar
  28. 28.
    Paterson AHG, Agarwal M, Lees A, Hanson J, Szafran O: Brain metastases in breast cancer patients receiving adjuvant chemotherapy. Cancer 49: 651–654, 1982Google Scholar
  29. 29.
    Gercovitch FG, Luna MA, Gottlieb JA: Increased incidence of cerebral metastases in sarcoma patients with prolonged survival from chemotherapy. Cancer 36:1843–1851, 1975Google Scholar
  30. 30.
    Viadana E, Bross ID, Pickren JW: An autopsy study of some routes of dissemination of cancer of the breast. Br J Cancer 27: 336–340, 1973Google Scholar
  31. 31.
    Sze G, Milano E, Johnson C, Heier L: Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. AJNR 11: 785–791, 1990Google Scholar
  32. 32.
    Shi M, Wallace S, Libshitz HL: Cranial computed tomography of breast carcinoma. J Comput Tomogr 6: 77–88, 1982Google Scholar

Copyright information

© Kluwer Academic Publishers 1993

Authors and Affiliations

  • W. Boogerd
    • 1
  • V. W. Vos
    • 1
  • A. A. M. Hart
    • 2
  • G. Baris
    • 2
  1. 1.Department of Neurology of the Netherlands Cancer Institute/Antoni van Leeuwenhoek ZiekenhuisAmsterdamThe Netherlands
  2. 2.Department of Radiotherapy of the Netherlands Cancer Institute/Antoni van Leeuwenhoek ZiekenhuisAmsterdamThe Netherlands

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