Treating Brain Metastases from Breast Cancer: Outcomes after Stereotactic Radiosurgery |
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| Institution: | 1. Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK;2. Population Health Sciences, University of Bristol, Bristol, UK;3. University Hospitals Southampton NHS Foundation Trust, Southampton, UK;2. Clinical Effectiveness Unit, Royal College of Surgeons, London, UK;3. Department of Urology, Guy''s and St Thomas'' NHS Foundation Trust, London, UK;4. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK;5. Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK;7. Department of Radiotherapy, Guy''s and St Thomas'' NHS Foundation Trust, London, UK;1. Ministry of Health, Chilaw, Sri Lanka;2. Sri Lanka Cancer Research Group, Maharagama, Sri Lanka;3. Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK;4. The Christie NHS Foundation Trust, Manchester, UK;1. NHS England & Royal College of Radiologists, London, UK;2. Royal College of Radiologists, London, UK;1. School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK;2. Radiotherapy Research Group, Leeds Institute of Medical Research at St James''s, Faculty of Medicine & Health, University of Leeds, Leeds, UK;3. Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK;4. Department of Medical Physics & Biomedical Engineering, University College London, London, UK;5. CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK;7. Velindre Cancer Centre, Cardiff, UK;1. University Plymouth Hospitals NHS Trust, Plymouth, UK;2. Royal Cornwall Hospitals Trust, Truro, UK;3. Lancashire Teaching Hospitals NHS Trust, Preston, UK;4. University of Plymouth School of Biological and Marine Sciences, Plymouth, UK;5. NIHR Lancashire Clinical Research Facility, Preston, UK;1. Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK;2. Department of Radiotherapy Physics, Mount Vernon Cancer Centre, Northwood, UK;3. Department of Acute Medicine, University Hospital Lewisham, London, UK;4. Department of Clinical Oncology, St Bartholomew''s Hospital, London, UK;5. Division of Cancer Sciences, The University of Manchester, Manchester, UK |
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| Abstract: | AimsStereotactic radiosurgery (SRS) is an alternative to surgery or whole brain radiotherapy for the control of single or multiple brain metastases in patients with breast cancer. To date, there is no clear consensus on factors that might predict overall survival following SRS. The aim of this study was to assess the overall survival of breast cancer patients with brain metastases treated with SRS at a single centre and to examine the factors that might influence survival.Materials and methodsA retrospective analysis of consecutive patients with breast cancer and brain metastases, considered suitable for SRS by the regional neuro-oncology multidisciplinary team. All patients were treated at a single National Health Service centre.ResultsIn total, 91 patients received SRS between 2013 and 2017, of whom 15 (16.5%) were alive at the time of analysis. The median overall survival post-SRS was 15.7 months (interquartile range 7.7–23.8 months) with no significant effect of age on survival (67 patients ≤ 65 years, 16.3 months; 26 patients > 65 years, 11.4 months, P = 0.129). The primary tumour receptor status was an important determinant of outcome: 31 oestrogen receptor positive (ER+)/human epidermal growth factor receptor 2 negative (HER2–) patients had a median overall survival of 13.8 months, 14 ER+/HER2+ patients had a median overall survival of 21.4 months, 30 ER–/HER2+ patients had a median overall survival of 20.4 months and 16 patients with triple negative breast cancer (TNBC) had a median overall survival of 8.5 months. A larger total volume of tumour treated (>10 cm3), but not the number of individual metastases treated, was associated with worse survival (P = 0.0002) in this series. Patients with stable extracranial disease at the time of SRS had improved overall survival compared with those with progressive extracranial disease (30 patients stable extracranial disease overall survival = 20.1 months versus 33 patients progressive extracranial disease overall survival = 11.4 months; P = 0.0011). Seventeen patients had no extracranial disease at the time of SRS, with a median overall survival of 13.1 months.ConclusionsThis single-centre series of consecutive patients with brain metastases from breast cancer, treated with SRS, had a similar overall survival compared with previous studies of SRS. TNBC and ER+/HER2– histology, metastatic volumes >10 cm3 and progressive extracranial disease at the time of SRS were associated with worse survival. |
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| Keywords: | Brain metastases breast cancer factors influencing survival intracranial disease stereotactic radiosurgery survival |
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