Skip to main content

Advertisement

SpringerLink
Log in

Inflammatory breast cancer and development of brain metastases: risk factors and outcomes

  • Brief Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Brain metastases are associated with significant morbidity. Minimal research has been conducted on the risk factors for and incidence of brain metastases in women with inflammatory breast cancer (IBC). 210 women with Stage III or IV IBC diagnosed from 1997–2011 were identified. Competing risk analysis and competing risks regression were used to calculate the incidence of brain metastases and identify significant risk factors. After a median follow-up in surviving patients of 2.8 years (range 0.6–7.6) and 3.3 years (range 0.2–14.5) in the 47 and 163 patients with (MET) and without (non-MET) metastatic disease at diagnosis, 17 (36 %) and 30 (18 %) developed brain metastases, respectively. The cumulative incidence at 1, 2, and 3 years was 17 % [95 % confidence interval (CI), 8–30], 34 % (95 % CI, 20–48), and 37 % (95 % CI, 22–51) for the MET cohort. The corresponding non-MET values were 4 % (95 % CI, 2–8), 8 % (95 % CI 5–13), and 15 % (95 % CI, 10–22). Once non-MET patients developed extracranial distant metastases, the subsequent 1, 2, and 3 years cumulative incidence of brain metastases was 18 % (95 % CI, 10–28), 25 % (95 % CI, 15–36), and 31 % (95 % CI, 20–43). On multivariate analysis, brain metastases were associated with younger age [hazard ratio (HR), 0.73; 95 % CI, 0.53–1.00; P = 0.05] and distant metastases at diagnosis (HR, 2.33; 95 % CI, 1.11–4.89; P = 0.03). The incidence of brain metastases is high in women with IBC. Particularly for patients with extracranial distant metastases, routine screening with magnetic resonance imaging should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Lee YT (1983) Breast carcinoma: pattern of metastasis at autopsy. J Surg Oncol 23(3):175–180

    Article  CAS  PubMed  Google Scholar 

  2. Tsukada Y, Fouad A, Pickren JW, Lane WW (1983) Central nervous system metastasis from breast carcinoma Autopsy study. Cancer 52(12):2349–2354

    Article  CAS  PubMed  Google Scholar 

  3. Patanaphan V, Salazar OM, Risco R (1988) Breast cancer: metastatic patterns and their prognosis. South Med J 81(9):1109–1112

    Article  CAS  PubMed  Google Scholar 

  4. Kennecke H, Yerushalmi R, Woods R, Cheang MCU, Voduc D, Speers CH et al (2010) Metastatic behavior of breast cancer subtypes. J Clin Oncol 28(20):3271–3277

    Article  PubMed  Google Scholar 

  5. Leyland-Jones B (2009) Human epidermal growth factor receptor 2-positive breast cancer and central nervous system metastases. J Clin Oncol 27(31):5278–5286

    Article  PubMed  Google Scholar 

  6. Boogerd W, Vos VW, Hart AA, Baris G (1993) Brain metastases in breast cancer; natural history, prognostic factors and outcome. J Neurooncol 15(2):165–174

    Article  CAS  PubMed  Google Scholar 

  7. Arvold ND, Oh KS, Niemierko A, Taghian AG, Lin NU, Abi-Raad RF et al (2012) Brain metastases after breast-conserving therapy and systemic therapy: incidence and characteristics by biologic subtype. Breast Cancer Res Treat 136(1):153–160

    Article  PubMed  Google Scholar 

  8. Stemmler H-J, Schmitt M, Willems A, Bernhard H, Harbeck N, Heinemann V (2007) Ratio of trastuzumab levels in serum and cerebrospinal fluid is altered in HER2-positive breast cancer patients with brain metastases and impairment of blood-brain barrier. Anticancer Drugs 18(1):23–28

    Article  CAS  PubMed  Google Scholar 

  9. Nguyen DX, Bos PD, Massagué J (2009) Metastasis: from dissemination to organ-specific colonization. Nat Rev Cancer 9(4):274–284

    Article  CAS  PubMed  Google Scholar 

  10. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70(2):510–514

    Article  PubMed  Google Scholar 

  11. Nieder C, Marienhagen K, Geinitz H, Molls M (2009) Validation of the graded prognostic assessment index for patients with brain metastases. Acta Oncol 48(3):457–459

    Article  PubMed  Google Scholar 

  12. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T 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(4):745–751

    Article  CAS  PubMed  Google Scholar 

  13. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322(8):494–500

    Article  CAS  PubMed  Google Scholar 

  14. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280(17):1485–1489

    Article  CAS  PubMed  Google Scholar 

  15. Horton J, Baxter DH, Olson KB (1971) The management of metastases to the brain by irradiation and corticosteroids. Am J Roentgenol Radium Ther Nucl Med 111(2):334–336

    Article  CAS  PubMed  Google Scholar 

  16. Niwińska A, Tacikowska M, Murawska M (2010) The effect of early detection of occult brain metastases in HER2-positive breast cancer patients on survival and cause of death. Int J Radiat Oncol Biol Phys 77(4):1134–1139

    Article  PubMed  Google Scholar 

  17. Miller KD, Weathers T, Haney LG, Timmerman R, Dickler M, Shen J et al (2003) Occult central nervous system involvement in patients with metastatic breast cancer: prevalence, predictive factors and impact on overall survival. Ann Oncol 14(7):1072–1077

    Article  CAS  PubMed  Google Scholar 

  18. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer [Internet]. 2014. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 1 March 2015

  19. Cristofanilli M, Valero V, Buzdar AU, Kau S-W, Broglio KR, Gonzalez-Angulo AM et al (2007) Inflammatory breast cancer (IBC) and patterns of recurrence: understanding the biology of a unique disease. Cancer 110(7):1436–1444

    Article  PubMed  Google Scholar 

  20. Anderson BWF, Chu KC, Chang S (2003) Inflammatory breast carcinoma and noninflammatory Locally advanced breast carcinoma : distinct clinicopathologic entities? J Clin Oncol 21(12):2254–2259

    Article  PubMed  Google Scholar 

  21. Chang S, Parker SL, Pham T, Buzdar AU, Hursting SD (1998) Inflammatory breast carcinoma incidence and survival the surveillance, epidemiology, and end results program of the National Cancer. Cancer 82(12):2366–2372

    Article  CAS  PubMed  Google Scholar 

  22. Lentzsch S, Reichardt P, Weber F, Budach V, Dörken B (1999) Brain metastases in breast cancer: prognostic factors and management. Eur J Cancer 35(4):580–585

    Article  CAS  PubMed  Google Scholar 

  23. Gonzalez-Angulo AM, Cristofanilli M, Strom EA, Buzdar AU, Kau S-W, Broglio KR et al (2004) Central nervous system metastases in patients with high-risk breast carcinoma after multimodality treatment. Cancer 101(8):1760–1766

    Article  PubMed  Google Scholar 

  24. Dawood S, Ueno NT, Valero V, Andreopoulou E, Hsu L, Lara J et al (2010) Incidence of and survival following brain metastases among women with inflammatory breast cancer. Ann Oncol 22(3):2348–2355

    Article  Google Scholar 

  25. Edge SB, Byrd, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, Trotti A (eds) (2011) American Joint Committee on Cancer Staging Manual, 7th edn. Springer, Chicago

    Google Scholar 

  26. Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA et al (2011) International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol 22(3):515–523

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Gray R (1988) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154

    Article  Google Scholar 

  28. Choudhury JB (2002) Non-parametric confidence interval estimation for competing risks analysis: application to contraceptive data. Stat Med 21(8):1129–1144

    Article  PubMed  Google Scholar 

  29. Scrucca L, Santucci A, Aversa F (2007) Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transplant 40(4):381–387

    Article  CAS  PubMed  Google Scholar 

  30. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53(282):457–481

    Article  Google Scholar 

  31. Greenwood M (1926) The errors of sampling of the survivorship tables. Rep Public Heal Stat Subj 33(1):26

    Google Scholar 

  32. DiStefano A, Yong Yap Y, Hortobagyi GN, Blumenschein GR (1979) The natural history of breast cancer patients with brain metastases. Cancer 44(5):1913–1918

    Article  CAS  PubMed  Google Scholar 

  33. Altundag K, Bondy ML, Mirza NQ, Kau S-W, Broglio K, Hortobagyi GN et al (2007) Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastasis. Cancer 110(12):2640–2647

    Article  CAS  PubMed  Google Scholar 

  34. Zimm S, Wampler GL, Stablein D, Hazra T, Young HF (1981) Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer 48(2):384–394

    Article  CAS  PubMed  Google Scholar 

  35. Tsao M, Xu W, Sahgal A (2012) A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer 118(9):2486–2493

    Article  PubMed  Google Scholar 

  36. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 10(11):1037–1044

    Article  PubMed  Google Scholar 

  37. Halasz LM, Weeks JC, Neville BA, Taback N, Punglia RS (2013) Use of stereotactic radiosurgery for brain metastases from non-small cell lung cancer in the United States. Int J Radiat Oncol Biol Phys 85(2):e109–e116

    Article  PubMed Central  PubMed  Google Scholar 

  38. Guadagnolo BA, Huo J, Liao K-P, Buchholz TA, Das P (2013) Changing trends in radiation therapy technologies in the last year of life for patients diagnosed with metastatic cancer in the United States. Cancer 119(5):1089–1097

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

There was no specific funding for this research. The authors do not have any specific acknowledgements.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Harvard Radiation Oncology Program, Boston, MA, USA

    Laura E. G. Warren

  2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Hao Guo & Meredith M. Regan

  3. Department of Surgery, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

    Faina Nakhlis

  4. Division of Breast Imaging, Department of Radiology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

    Eren D. Yeh

  5. Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

    Heather A. Jacene

  6. Department of Medical Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

    Judi Hirshfield-Bartek & Beth A. Overmoyer

  7. Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Jennifer R. Bellon

Authors
  1. Laura E. G. Warren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hao Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meredith M. Regan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faina Nakhlis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eren D. Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heather A. Jacene
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Judi Hirshfield-Bartek
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Beth A. Overmoyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jennifer R. Bellon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer R. Bellon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Warren, L.E.G., Guo, H., Regan, M.M. et al. Inflammatory breast cancer and development of brain metastases: risk factors and outcomes. Breast Cancer Res Treat 151, 225–232 (2015). https://doi.org/10.1007/s10549-015-3381-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3381-8

Keywords

Search

Navigation