Journal of Neuro-Oncology

, Volume 86, Issue 2, pp 231–238 | Cite as

Treatment and prognosis of brain metastases from breast cancer

  • Kazuhiko Ogawa
  • Yoshihiko Yoshii
  • Tadashi Nishimaki
  • Nobumitsu Tamaki
  • Takao Miyaguni
  • Yukihiro Tsuchida
  • Yoshihiko Kamada
  • Takafumi Toita
  • Yasumasa Kakinohana
  • Wakana Tamaki
  • Shiro Iraha
  • Genki Adachi
  • Akio Hyodo
  • Sadayuki Murayama
Clinical-patient studies

Abstract

Background To analyze retrospectively the results of treatments for patients with brain metastases from breast cancer. Materials and Methods The records of 65 breast cancer patients with brain metastases who were treated between 1985 and 2005 were reviewed. For brain metastases, 11 patients (17%) were treated with surgical resection followed by radiotherapy, and the remaining 54 patients were treated with radiotherapy alone. Systemic chemotherapy was also administered to 11 patients after brain radiotherapy. Results The overall median survival for all patients was 6.1 months (range, 0.4–82.2 months). In univariate analysis, treatment modality, Karnofsky performance status (KPS), administration of systemic chemotherapy, extracranial disease status and total radiation dose each had significant impact on overall survival, and in multivariate analysis, treatment modality, KPS and administration of systemic chemotherapy were significant prognostic factors. Eight patients survived for more than 2 years after the diagnosis of brain metastases, and all these patients were treated with surgical resection and/or systemic chemotherapy in addition to radiotherapy. For the 45 patients treated with palliative radiotherapy (without systemic chemotherapy), the improvements in neurological symptoms were observed in 35 patients (78%), with the median duration of improvement of 3.1 months (range, 1.5–4.4 months). Conclusions The prognoses for patients with brain metastases from breast cancer were generally poor, although selected patients may survive longer with intensive brain tumor treatment, such as surgical resection and/or systemic chemotherapy in addition to brain radiotherapy. For patients with unfavorable prognoses, palliative radiotherapy was effective in improving the quality of the remaining lifetime.

Keywords

Radiation therapy Brain metastasis Breast neoplasms Surgical resection Chemotherapeutic 

References

  1. 1.
    Loeffler JS, Patchell RA, Sawata R (1997) Metastatic brain tumor. In: Devita VT Jr, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, 5th edn. Lippincott-Raven, Philadelphia, pp 2523–2536Google Scholar
  2. 2.
    Phillips TL, Scott CB, Leibel SA et al (1995) Results of a randomized comparison of radiotherapy and bromodeoxyuridine with radiotherapy alone for brain metastases: report of RTOG trial 89–05. Int J Radiat Oncol Biol Phys 33:339–348PubMedCrossRefGoogle Scholar
  3. 3.
    Borgelt B, Gelber R, Kramer S et al (1980) The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 6:1–9PubMedGoogle Scholar
  4. 4.
    Lee YT (1983) Breast carcinoma: pattern of metastasis at autopsy. J Surg Oncol 23:175–180PubMedCrossRefGoogle Scholar
  5. 5.
    DiStefano A, Yong Yap Y, Hortobagyi GN et al (1979) The natural history of breast cancer patients with brain metastases. Cancer 44:1913–1918PubMedCrossRefGoogle Scholar
  6. 6.
    Chang EL, Lo S (2003) Diagnosis and management of central nervous system metastases from breast cancer. Oncologist 8:398–410PubMedCrossRefGoogle Scholar
  7. 7.
    Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500PubMedCrossRefGoogle Scholar
  8. 8.
    Zimm S, Wampler GL, Stablein D et al (1981) Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer 48:384–394PubMedCrossRefGoogle Scholar
  9. 9.
    Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751PubMedCrossRefGoogle Scholar
  10. 10.
    Kaplan EL, Meier P (1985) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  11. 11.
    Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:163–170PubMedGoogle Scholar
  12. 12.
    Cox DR (1972) Regression models and life tables. J R Stat Soc 34:187–220Google Scholar
  13. 13.
    Agboola O, Benoit B, Cross P et al (1998) Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases. Int J Radiat Oncol Biol Phys 42:155–159PubMedCrossRefGoogle Scholar
  14. 14.
    Gaspar LE, Scott C, Murray K et al (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47:1001–1006PubMedCrossRefGoogle Scholar
  15. 15.
    Yamada K, Murakami M, Kuroda Y (1997) Treatment results of brain metastases from breast cancer: course of the disease and radiation therapy. Nippon Igaku Hoshasen Gakkai Zasshi 57:34–40 (in Japanese)PubMedGoogle Scholar
  16. 16.
    Boogerd W (1996) Central nervous system metastases in breast cancer. Radiother Oncol 40:5–22PubMedCrossRefGoogle Scholar
  17. 17.
    Wronski M, Arbit E, McCormick B (1997) Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer 80:1746–1754PubMedCrossRefGoogle Scholar
  18. 18.
    Vecht CJ, Haaxma-Reiche H, Noordijk EM et al (1993) Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590PubMedCrossRefGoogle Scholar
  19. 19.
    Breneman JC, Warnick RE, Albright RE et al (1997) Stereotactic ardiosurgery for the treatment of brain metastases. Results of a single institution series. Cancer 79:551–557PubMedCrossRefGoogle Scholar
  20. 20.
    Adler JR, Cox RS, Kaplan I et al (1992) Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76:444–449PubMedCrossRefGoogle Scholar
  21. 21.
    Saito EY, Viani GA, Ferrigno R et al (2006) Whole brain radiation therapy in management of brain metastasis: results and prognostic factors. Radiat Oncol 1:20PubMedCrossRefGoogle Scholar
  22. 22.
    Workman P (1986) The pharmacology of brain tumour chemotherapy. In: Bleehen NM (ed) Tumours of the brain. Springer-Verlag, Berlin, pp 183–200Google Scholar
  23. 23.
    Greig NH (1989) Brain tumors and the blood-brain barrier. In: Neuwelt EA (ed) Implications of the blood–brain barrier and its manipulation, Vol 2. Plenum, New York, pp 77–106Google Scholar
  24. 24.
    Fortin D, Gendron C, Boudrias M et al (2007) Enhanced chemotherapy delivery by intraarterial infusion and blood–brain barrier disruption in the treatment of cerebral metastasis. Cancer 109:751–760PubMedCrossRefGoogle Scholar
  25. 25.
    Rosner D, Nemoto T, Lane WW (1986) Chemotherapy induces regression of brain metastases in breast carcinoma. Cancer 58:832–839PubMedCrossRefGoogle Scholar
  26. 26.
    Bartsch R, Fromm S, Rudas M et al (2006) Intensified local treatment and systemic therapy significantly increase survival in patients with brain metastases from advanced breast cancer-a retrospective analysis. Radiother Oncol 80:313–317PubMedCrossRefGoogle Scholar
  27. 27.
    Boogerd W, Dalesio O, Bais EM et al (1992) Response of brain metastases from breast cancer to systemic chemotherapy. Cancer 69:972–980PubMedCrossRefGoogle Scholar
  28. 28.
    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
  29. 29.
    Colleoni M, Graiff C, Nelli P et al (1997) Activity of combination chemotherapy in brain metastases from breast and lung adenocarcinoma. Am J Clin Oncol 20:303–307PubMedCrossRefGoogle Scholar
  30. 30.
    Snee MP, Rodger A, Kerr GR (1985) Brain metastases from carcinoma of breast: a review of 90 cases. Clin Radiol 36:365–367PubMedCrossRefGoogle Scholar
  31. 31.
    Ogura M, Mitsumori M, Okumura S et al (2003) Radiation therapy for brain metastases from breast cancer. Breast Cancer 10:349–355PubMedGoogle Scholar
  32. 32.
    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
  33. 33.
    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 54:810–817PubMedCrossRefGoogle Scholar
  34. 34.
    Le Scodan R, Massard C, Mouret-Fourme E et al (2007) Brain metastases from breast carcinoma: validation of the Radiation Therapy Oncology Group recursive partitioning analysis classification and proposition of a new prognostic score. Int J Radiat Oncol Biol Phys doi: 10.1016/j.irobp.2007.04.024
  35. 35.
    Kocher M, Muller RP, Staar S et al (1995) Long-term survival after brain metastases in breast cancer. Strahlenther Onkol 171:290–295PubMedGoogle Scholar
  36. 36.
    Kurtz JM, Gelber R, Brady LW et al (1981) 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 7:891–895PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Kazuhiko Ogawa
    • 1
  • Yoshihiko Yoshii
    • 2
  • Tadashi Nishimaki
    • 3
  • Nobumitsu Tamaki
    • 4
  • Takao Miyaguni
    • 3
  • Yukihiro Tsuchida
    • 2
  • Yoshihiko Kamada
    • 4
  • Takafumi Toita
    • 1
  • Yasumasa Kakinohana
    • 1
  • Wakana Tamaki
    • 1
  • Shiro Iraha
    • 1
  • Genki Adachi
    • 1
  • Akio Hyodo
    • 2
  • Sadayuki Murayama
    • 1
  1. 1.Department of RadiologyUniversity of the Ryukyus School of MedicineNishihara-choJapan
  2. 2.Department of NeurosurgeryUniversity of the RyukyusNishihara-choJapan
  3. 3.Department of SurgeryUniversity of the RyukyusNishihara-choJapan
  4. 4.Department of SurgeryNaha West ClinicNaha cityJapan

Personalised recommendations