Brain metastases in breast cancer: a retrospective cohort study of 187 patients and prognostic markers determination.

SVOBODA, Marek, Pavel FABIAN, Barbora ONDROVÁ, Markéta PALÁCOVÁ, Peter GRELL, Jana GOMBOŠOVÁ, Denis PRINC, Ondřej SLABÝ, Pavel ŠLAMPA and Rostislav VYZULA. Brain metastases in breast cancer: a retrospective cohort study of 187 patients and prognostic markers determination. Breast Cancer Research and Treatment. Nizozemí: Springer, 2007, vol. 106, Supp1, p. S253, 1 pp. ISSN 0167-6806.

Basic information

• Original name: Brain metastases in breast cancer: a retrospective cohort study of 187 patients and prognostic markers determination.
• Name in Czech: Metastatické postižení mozku u pacientek s karcinomem prsu: retrospektivní studie 187 pacientek a identifikace prognostických markerů.
• Authors: SVOBODA, Marek, Pavel FABIAN, Barbora ONDROVÁ, Markéta PALÁCOVÁ, Peter GRELL, Jana GOMBOŠOVÁ, Denis PRINC, Ondřej SLABÝ, Pavel ŠLAMPA and Rostislav VYZULA.
• Edition: Breast Cancer Research and Treatment, Nizozemí, Springer, 2007, 0167-6806.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30200 3.2 Clinical medicine
• Country of publisher: Netherlands
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 4.453
• Organization unit: Faculty of Medicine
• UT WoS: 000251398500711
• Keywords in English: breast cancer;brain metastases;triple negative breast cancer;basal-like breast cancer;HER-2 receptor;prediction;progosis
• Tags: basal-like breast cancer, brain metastases, breast cancer, HER-2 receptor, Prediction, progosis, triple negative breast cancer
• Tags: International impact, Reviewed

Abstract

Introduction: Central nervous system metastases (mts CNS) are the most important cause of morbidity and mortality. Despite of the fact that most of these patients (pts) die within a few months, substantial subgroup may survive a year or more. We performed this study to determine factors influencing: incidence, the interval between the disease diagnosis and the mt CNS (TTPcns) and overall survival since the development of metastases in brain (OScns). Methods: We studied a cohort of 187 breast cancer pts who developed mts CNS limited to the brain and were treated at our centre from 1997 to 2007. Immunohistochemistry was performed to determine following phenotypes: 1. triple-negative, 2. triple-negative/basal-like, 3. ER+/Her-2-, 4. Her-2+/ER-, 5. Her-2+/ER+, 6. ER-/PR-/Her-2X. Results: An initial treatment started with a neurosurgery in 11%, WBRT in 87%, and followed by systemic therapy in 35,5% of pts. At the time of the mts CNS identification, 56,5% of pts had progression of the extra-cranial part of the tumor. 28 (15%) pts had developed mts CNS as the first metastatic site and 31 pts (16%) on the trastuzumab based-therapy. The incidence of monitored phenotypes was subsequent: 1. 19,4%; 2. 9,1%; 3. 21,5%; 4. 19,9%; 5. 16,7%; 6. 6,9%. Significant correlation between the phenotype and TTPcns and interval between the first distant metastatic event and the metastases in the CNS (TTPmts-cns) has been proven. In contrast to OS, the tumor phenotype had no influence on OScns. The following positive predictors relating to the prolonged OScns have been found: the number of metastatic foci in the CNS (p=0.0016); the management of local and systemic cancer treatment (p<0,0001);neurosurgery (13,8vs2,4 months, p<0.0001); systemic therapy after the effective local treatment (6,1vs1,9 months, p<0,0001); and, in the case of a further disease progression in CNS, this progression was handled by the change of the system treatment and/or by local therapy (median 10.9 vs 4.4 months, p=0.00006). The longest OScns were seen in the pts who received a dose of WBRT more than 27Gy (4,7vs2.5 months, p<0,0001). Conclusion: A comprehensive approach to patients with breast cancer and brain metastases can significantly increase OScns. This approach is based on early detection of metastases in patients with a risk tumor phenotype, intensified local treatment and systemic therapy. Supported by grant IGA Ministry of Health, CZ. No.: NR/8335-3.

Abstract (in Czech)

Introduction: Central nervous system metastases (mts CNS) are the most important cause of morbidity and mortality. Despite of the fact that most of these patients (pts) die within a few months, substantial subgroup may survive a year or more. We performed this study to determine factors influencing: incidence, the interval between the disease diagnosis and the mt CNS (TTPcns) and overall survival since the development of metastases in brain (OScns). Methods: We studied a cohort of 187 breast cancer pts who developed mts CNS limited to the brain and were treated at our centre from 1997 to 2007. Immunohistochemistry was performed to determine following phenotypes: 1. triple-negative, 2. triple-negative/basal-like, 3. ER+/Her-2-, 4. Her-2+/ER-, 5. Her-2+/ER+, 6. ER-/PR-/Her-2X. Results: An initial treatment started with a neurosurgery in 11%, WBRT in 87%, and followed by systemic therapy in 35,5% of pts. At the time of the mts CNS identification, 56,5% of pts had progression of the extra-cranial part of the tumor. 28 (15%) pts had developed mts CNS as the first metastatic site and 31 pts (16%) on the trastuzumab based-therapy. The incidence of monitored phenotypes was subsequent: 1. 19,4%; 2. 9,1%; 3. 21,5%; 4. 19,9%; 5. 16,7%; 6. 6,9%. Significant correlation between the phenotype and TTPcns and interval between the first distant metastatic event and the metastases in the CNS (TTPmts-cns) has been proven. In contrast to OS, the tumor phenotype had no influence on OScns. The following positive predictors relating to the prolonged OScns have been found: the number of metastatic foci in the CNS (p=0.0016); the management of local and systemic cancer treatment (p<0,0001);neurosurgery (13,8vs2,4 months, p<0.0001); systemic therapy after the effective local treatment (6,1vs1,9 months, p<0,0001); and, in the case of a further disease progression in CNS, this progression was handled by the change of the system treatment and/or by local therapy (median 10.9 vs 4.4 months, p=0.00006). The longest OScns were seen in the pts who received a dose of WBRT more than 27Gy (4,7vs2.5 months, p<0,0001). Conclusion: A comprehensive approach to patients with breast cancer and brain metastases can significantly increase OScns. This approach is based on early detection of metastases in patients with a risk tumor phenotype, intensified local treatment and systemic therapy. Supported by grant IGA Ministry of Health, CZ. No.: NR/8335-3.

Links

• NR8335, research and development project: Name: Predikce chemosenzitivity / chemorezistence na cílenou protinádorovou terapii u pacientek s karcinomem prsu s prokázanou HER-2 pozitivitou, na podkladě analýzy Akt signální dráhy a sérové hladiny HER-2 receptoru