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Breast cancer patients with brain metastasis undergoing GKRS

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Abstract

Background

Breast cancer (BC) is the second most common cause of brain metastasis in the United States. Compared to whole brain radiation therapy (WBRT), treatment with gamma-knife radiosurgery (GKRS) offers a better chance at neurocognitive preservation. The goal of our retrospective study is to report the overall survival (OS) in patients receiving GKRS and to identify factors that improve survival outcomes.

Methods

The records of 80 patients with primary BC treated with GKRS at the Yale Comprehensive Cancer Center between 2000 and 2013 were reviewed. OS was calculated from the date of first GKRS treatment. Other factors studied were age, Karnofsky performance status (KPS), tumor subtype, having WBRT and/or surgical resection pre- or post-GKRS, and number of brain metastases treated with GKRS.

Results

Median age was 56.2 years. OS from first GKRS was 13.1 months (95% CI 7.6–21.9). On univariate analysis, improved survival was associated with HER-2 subtype (p = 0.026), KPS score > 80 (p = 0.009), and good control of systemic disease at time of GKRS (p = 0.020). Multivariable analysis detected a significantly longer survival with HER-2 positivity (HR 0.22, 95% CI 0.06–0.76, p = 0.017) and a strong trend in patients with craniotomy prior to GKRS (HR 0.13, 95% CI 0.01–1.11, p = 0.06).

Conclusions

GKRS is a promising therapy for treating brain metastasis from BC, particularly in those with HER-2 positivity and high-performance scores even in those patients with > 5 brain metastases. Furthermore, GKRS may also be a useful adjunct to surgical resection in such patients. High rates of neurological death remain from BC brain metastases; however, and need further investigation.

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References

  1. Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. SEER Cancer Statistics Review, 1975–2013, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER web site. Accessed April 2016.

  2. Metastatic Brain Tumors. American Brain Tumor Association, 2016. PDF.

  3. Jaboin JJ, Ferraro DJ, Dewees TA, et al. Survival following gamma knife radiosurgery for brain metastasis from breast cancer. Radiat Oncol. 2013;8:131.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Niikura N, Hayashi N, Masuda N, et al. Treatment outcomes and prognostic factors for patients with brain metastases from breast cancer of each subtype: a multicenter retrospective analysis. Breast Cancer Res Treat. 2014;147(1):103–12.

    Article  PubMed  Google Scholar 

  5. Niwińska A, Murawska M, Pogoda K. Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). Ann Oncol. 2010;21(5):942–8.

    Article  PubMed  Google Scholar 

  6. Roehrig AT, Ferrel EA, Benincosa DA, et al. Pretreatment clinical prognostic factors for brain metastases from breast cancer treated with Gamma Knife radiosurgery. Surg Neurol Int. 2016;7(suppl 35):830–6.

    Google Scholar 

  7. Brown P, Asher A, Ballman K, et al. NCCTG N0574 (Alliance): a phase III randomized trial of whole brain radiation therapy (WBRT) in addition to radiosurgery (SRS) in patients with 1 to 3 brain metastases. J Clin Oncol. 2015;33(18_suppl):LBA4

    Article  Google Scholar 

  8. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomized controlled trial. Lancet Oncol. 2009 10(11):1037–44.

    Article  PubMed  Google Scholar 

  9. Yamamoto M. Serizawa T, Shuto T, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014;15(4):387–95.

    Article  PubMed  Google Scholar 

  10. Cho E, Rubinstein L, Redman M, et al. Differentiation of overall survival by breast cancer tumor subtype following stereotactic radiosurgery for brain metastasis. J Clin Oncol. 2014;32(15_suppl):e1184.

    Google Scholar 

  11. Matsunaga S, Shuto T, Kawahara N, et al. Gamma Knife surgery for metastatic brain tumor for primary breast cancer: treatment indication based on numbers of tumor and breast cancer phenotype. J Neurosurg. 2010;113:65–72.

    Article  PubMed  Google Scholar 

  12. Dijkers EC, Oude munnink TH, Kosterink JG, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87(5):586–92.

    Article  PubMed  CAS  Google Scholar 

  13. Stemmler HJ, Schmitt M, Willems A, Bernhard H, Harbeck N, Heinemann V. 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. 2007;18(1):23–8.

    Article  PubMed  CAS  Google Scholar 

  14. Kondziolka D, Martin JJ, Flickinger JC, et al. Long-term survivors after gamma knife radiosurgery for brain metastases. Cancer. 2005;104(12):2784–91.

    Article  PubMed  Google Scholar 

  15. Goyal S, Prasad D, Harrell F, Matsumoto J, Rich T, Steiner L. Gamma knife surgery for the treatment of intracranial metastases from breast cancer. J Neurosurg. 2005;103(2):218–23.

    Article  PubMed  Google Scholar 

  16. Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77(3):655–61.

    Article  PubMed  Google Scholar 

  17. Sperduto PW, Kased N, Roberge D, et al. The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys 2012 April 1;82(5):2111–2117.

  18. Yamamoto M, Kawabe T, Hiquchi Y, et al. Validity of three recently proposed prognostic grading indexes for breast cancer patients with radiosurgically treated brain metastases. Int J Radiat Oncol Biol Phys. 2012;84(5):1110–5.

    Article  PubMed  Google Scholar 

  19. Kased N, Binder DK, Mcdermott MW, et al. Gamma Knife radiosurgery for brain metastases from primary breast cancer. Int J Radiat Oncol Biol Phys. 2009;75(4):1132–40.

    Article  PubMed  Google Scholar 

  20. Park J-Y, Moon K-S, Lee K-H, et al. Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival. BMC Cancer. 2015;15:54.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Patel KR, Prabhu RS, Kandula S, et al. Intracranial control and radiographic changes with adjuvant radiation therapy for resected brain metastases: whole brain radiotherapy versus stereotactic radiosurgery alone. J NeuroOncol. 2014;120(3):657–63.

    Article  PubMed  CAS  Google Scholar 

  22. Oh BC, Pagnini PG, Wang MY, et al. Stereotactic radiosurgery: adjacent tissue injury and response after high-dose single fraction radiation: Part I—Histology, imaging and molecular events. Neurosurgery. 2007;60(1):31–44.

    Article  PubMed  Google Scholar 

  23. Chao ST, Ahluwahlia MS, Barnett GH, et al. Challenges with the diagnosis and treatment of cerebral radiation necrosis. Int J Radiat Oncol Biol Phys. 2013;87(3):449–57.

    Article  PubMed  Google Scholar 

  24. Nath SK, Sheridan AD, Rauch PJ, et al. Significance of histology in determining management of lesions regrowing after radiosurgery. J NeuroOncol. 2014;117(2):303–10.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, 7th Floor, Philadelphia, PA, 19107, USA

    Maysa Abu-Khalaf

  2. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Sivraj Muralikrishnan

  3. Section of Medical Oncology, Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT, USA

    Christos Hatzis

  4. Internal Medicine Residency Program, Yale New Haven Medical Center, New Haven, CT, USA

    Deepti Canchi

  5. Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA

    James B. Yu

  6. Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA

    Veronica Chiang

Authors
  1. Maysa Abu-Khalaf
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  2. Sivraj Muralikrishnan
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  3. Christos Hatzis
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  4. Deepti Canchi
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  5. James B. Yu
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  6. Veronica Chiang
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Corresponding author

Correspondence to Maysa Abu-Khalaf.

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Conflict of interest

James B. Yu: Research funding from twenty-first Century Oncology.

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Abu-Khalaf, M., Muralikrishnan, S., Hatzis, C. et al. Breast cancer patients with brain metastasis undergoing GKRS. Breast Cancer 26, 147–153 (2019). https://doi.org/10.1007/s12282-018-0903-3

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  • DOI: https://doi.org/10.1007/s12282-018-0903-3

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