Survival following gamma knife radiosurgery for brain metastasis from breast cancer

Radiation Oncology

Imran Zoberi⁵  Anushka H Patel¹  William J Magnuson³  Joseph R Simpson⁵  Robert E Drzymala⁵  David B Mansur²  Joshua L Dowling⁴  Michael R Chicoine⁴  Keith M Rich⁴  Todd A DeWees⁵  Daniel J Ferraro⁵  Jerry J Jaboin⁵ 

[1] Arizona Oncology Services, Phoenix, AZ, USA;Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA;Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA;Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA;Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA

关键词: Brain metastasis;    Breast cancer;    GKS;    Stereotactic radiosurgery;    Gamma knife;   

Others  :  1153854
DOI  :  10.1186/1748-717X-8-131

 received in 2012-10-03, accepted in 2013-05-23,  发布年份 2013

【 摘 要 】

Background

Breast cancer is the second most common cause of brain metastases in the United States. Although breast cancer induced brain metastases represent an incurable condition, some patients experience prolonged survival. In this retrospective study, we examine a cohort of patients with brain metastases from breast cancer treated with Gamma Knife stereotactic radiosurgery to identify factors that predict better outcomes.

Methods

A retrospective database of 100 patients treated for brain metastases due to breast cancer via Gamma Knife radiosurgery (GKS) from July 1998 through March 2009 was reviewed. Patients who received radiosurgery as sole treatment, as a planned boost after whole brain radiotherapy or surgical resection, or as salvage after prior whole brain radiation therapy (WBRT) or surgical resection were included. Prognostic factors identified to be significant for survival in previous brain metastasis studies were analyzed for significance by univariate and multivariate Cox analysis.

Results

Overall, the median brain progression-free survival time was 7.1 months and the median survival time was 12.3 months. No prognostic variables were significant for brain progression-free survival. For patients treated with a planned GKS after WBRT, GKS as sole treatment, GKS salvage after WBRT, GKS boost after surgery, or GKS for surgical salvage the median survival times (MSTs) were as follows: 12.2 months, 12.4 months, 9.5 months, 27.6 months and 33.4 months respectively. Differences between the groups were not significant (p = 0.06); however, GKS boost after surgery and GKS for salvage after surgery did have a trend toward better overall survival.

The MST for patients of age <65 years was 14.5 months, compared to age ≥65 which was 7.7 months (p = 0.06) and remained a significant prognostic factor for overall survival on multivariate analysis. The MST for patients with a single lesion was 16.9 months, not significantly different than the MST of 14.5 months for patients with 2–3 lesions. However patients with >3 lesions had a MST of 5.9 months, which was significantly worse. Breast cancer subtype as approximated by biomarkers and KPS were not significant predictors of overall survival and stage at initial diagnosis was inversely associated with survival.

Conclusion

Stereotactic radiosurgery offers good local control and prolonged survival in selected patients. Age and number of lesions are strong predictors of overall survival.

【 授权许可】

   
2013 Jaboin et al.; licensee BioMed Central Ltd.

【 图 表 】

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