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Breast Cancer Research and Treatment

, Volume 111, Issue 3, pp 523–530 | Cite as

Brain metastases in breast cancer: prognostic factors and management

  • Sung Sook Lee
  • Jin-Hee Ahn
  • Min Kyoung Kim
  • Sun Jin Sym
  • Gyungyub Gong
  • Seung Do Ahn
  • Sung-Bae Kim
  • Woo Kun KimEmail author
Epidemiology

Abstract

Background The purpose of this retrospective study was to analyze the overall survival of patients with brain metastases due to breast cancer and to identify prognostic factors that affect clinical outcome. Methods Of the 7,872 breast cancer patients histologically diagnosed with breast cancer between January 1990 and July 2006 at the Asan Medical Center, 198 patients with solitary or multiple brain metastases were included in this retrospective study. Central nervous system (CNS) lesions were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). Patients with leptomeningeal or dural metastases without co-existent parenchymal metastatic lesions were excluded in this study. We reviewed the medical records and pathologic data of these 198 patients to characterize the clinical features and outcomes. Results The median age of the patients at the diagnosis of brain metastases was 45 years (range 26–78 years). Fifty-five patients (28%) had a single brain metastasis, whereas 143 (72%) had more than two metastases. A total of 157 (79.2%) patients received whole-brain radiation therapy (WBRT). A total of 7 (3.6%) patients underwent resection of solitary brain metastases, 22 (11%) patients underwent gamma-knife surgery, three patients underwent intrathecal chemotherapy (1.5%) and 9 (4.6%) patients received no treatment. The overall median survival time was 5.6 months (95% confidence interval (CI), 4.7–6.5 months) and 23.1% of the patients survived for more than 1 year. The median overall survival time was 5.4 months for patients treated with WBRT, 14.9 months for patients treated with surgery or gamma-knife surgery only, and 2.1 months for patients who received no treatment (P < 0.001). Multivariate analysis demonstrated that Eastern Cooperative Oncology Group (ECOG) performance status (relative risk (RR) = 0.704, 95% CI 0.482–1.028, P = 0.069), number of brain metastases (RR = 0.682, 95% CI 0.459–1.014, P = 0.058), treatment modalities (RR = 1.686, 95% CI 1.022–2.781, P = 0.041), and systemic chemotherapy after brain metastases (RR = 1.871, 95% CI 1.353–2.586, P < 0.001) were independent factors associated with survival. Conclusion Although survival of breast cancer patients with brain metastases was generally short, the performance status, number of brain metastases, treatment modalities and systemic chemotherapy after brain metastases were significantly associated with survival. Patients with single-brain metastasis and good performance status deserve aggressive treatment. The characteristics of initial primary breast lesions did not affect survival after brain metastasis.

Keywords

Metastatic breast cancer Brain metastases Prognostic factor 

References

  1. 1.
    Lee Y-T (1983) Breast carcinoma: pattern of metastasis at autopsy. J Surg Oncol 23:175–180PubMedCrossRefGoogle Scholar
  2. 2.
    DiStefano A, Yap HY, Hortobagyi GN et al (1979) The natural history of breast cancer patients with brain metastases. Cancer 44:1913–1918PubMedCrossRefGoogle Scholar
  3. 3.
    Bendell JC, Domchek SM, Burstein HJ et al (2003) Central nervous system metastases in women who receive trastuzumab-based therapy for metastatic breast carcinoma. Cancer 97:2972–2977PubMedCrossRefGoogle Scholar
  4. 4.
    Shmueli E, Wigler N, Inbar M (2004) Central nervous system progression among patients with metastatic breast cancer responding to trastuzumab treatment. Eur J Cancer 40:379–382PubMedCrossRefGoogle Scholar
  5. 5.
    Lower EE, Drosick DR, Blau R et al (2003) Increased rate of brain metastasis with trastuzumab therapy not associated with impaired survival. Clin Breast Cancer 4:114–119PubMedGoogle Scholar
  6. 6.
    Clayton AJ, Danson S, Jolly S et al (2004) Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer. Br J Cancer 91:639–643PubMedGoogle Scholar
  7. 7.
    Crivellari D, Pagani O, Veronesi A et al (2001) High incidence of central nervous system involvement in patients with metastatic or locally advanced breast cancer treated with epirubicin and docetaxel. Ann Oncol 12:353–356PubMedCrossRefGoogle Scholar
  8. 8.
    Kosmas C, Malamos NA, Tsavaris NB et al (2002) Leptomeningeal carcinomatosis after major remission to taxane-based front line therapy in patients with advanced breast cancer. J Neurooncol 56:265–273PubMedCrossRefGoogle Scholar
  9. 9.
    Chock J, Domchek S, Burstein H et al (2002) Central nervous system (CNS) metastases in women who receive trastuzumab for metastatic breast cancer (MBC) [abstract]. Proc Am Soc Clin Oncol 21:55aGoogle Scholar
  10. 10.
    Chang EL, Lo S (2003) Diagnosis and management of central nervous system metastases from breast cancer. Oncologist 8:398–410PubMedCrossRefGoogle Scholar
  11. 11.
    Coia LR (1992) The role of radiation therapy in the treatment of brain metastases. Int J Radiat Oncol Biol Phys 23:229–238PubMedGoogle Scholar
  12. 12.
    Gutin PH (1975) Corticosteroid therapy in patients with cerebral tumors: benefits, mechanisms, problems, practicalities. Semin Oncol 2:49–56PubMedGoogle Scholar
  13. 13.
    Posner J (1977) Management of central nervous system metastases. Semin Oncol 4:81–91PubMedGoogle Scholar
  14. 14.
    Pladdet I, Boven E, Nauta J et al (1989) Palliative care for brain metastases of solid tumour types. Neth J Med 34:10–21PubMedGoogle Scholar
  15. 15.
    Cairncross JG, Kim J-H, Posner JB (1980) Radiation therapy for brain metastases. Ann Neurol 7:529–541PubMedCrossRefGoogle Scholar
  16. 16.
    Mahmoud-Ahmed AS, Suh JH, Lee SY et al (2002) Results of whole brain radiotherapy in patients with brain metastases from breast cancer: a retrospective study. Int J Radiat Oncol Biol Phys 54:810–817PubMedGoogle Scholar
  17. 17.
    Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain [see comments]. N Engl J Med 322:494–500PubMedCrossRefGoogle Scholar
  18. 18.
    Ahn SH, Yoo KY, The Korean Breast Cancer Society (2006) Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996–2004. Breast Cancer Res Treat 99:209–214PubMedCrossRefGoogle Scholar
  19. 19.
    Son BH, Kwak BS, Kim JK et al (2006) Changing patterns in the clinical characteristics of Korean patients with breast cancer during the last 15 years. Arch Surg 141:155–160PubMedCrossRefGoogle Scholar
  20. 20.
    Tsukada Y, Fouad A, Pickren JW, Lane WW (1983) Central nervous system metastases from breast carcinoma: autopsy study. Cancer 52:2349–2354PubMedCrossRefGoogle Scholar
  21. 21.
    Boogerd W, Vos VW, Hart AAM et al (1993) Brain metastases in breast cancer; natural history, prognostic factors, and outcome. J Neurooncol 15:165–174PubMedCrossRefGoogle Scholar
  22. 22.
    Maki DD, Grossman RI (2000) Patterns of disease spread in metastatic breast carcinoma: influence of estrogen and progesterone receptor status. Am J Neuroradiol 21:1064–1066PubMedGoogle Scholar
  23. 23.
    Higashi H, Fukutomi T, Watanabe T et al (2000) Seven cases of breast cancer recurrence limited to the central nervous system without other visceral metastases. Breast Cancer 7:153–156PubMedCrossRefGoogle Scholar
  24. 24.
    Samaan NA, Buzdar AU, Aldinger KA et al (1981) Estrogen receptor: a prognostic factor in breast cancer. Cancer 47:554–560PubMedCrossRefGoogle Scholar
  25. 25.
    Tham Y-L, Sexton K, Kramer R et al (2006) Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer 107:696–704PubMedCrossRefGoogle Scholar
  26. 26.
    Lentzsch S, Reichardt P, Weber F et al (1999) Brain metastases in breast cancer: prognostic factors and management. Eur J Cancer 35:580–585PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2007

Authors and Affiliations

  • Sung Sook Lee
    • 1
  • Jin-Hee Ahn
    • 1
  • Min Kyoung Kim
    • 1
  • Sun Jin Sym
    • 1
  • Gyungyub Gong
    • 2
  • Seung Do Ahn
    • 3
  • Sung-Bae Kim
    • 1
  • Woo Kun Kim
    • 1
    Email author
  1. 1.Division of Oncology, Department of Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  3. 3.Department of Radiation Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea

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