Berrin Benli YAVUZ, Gul KANYILMAZ, Meryem AKTAN

The analysis of prognostic factors and treatment outcomes in breast cancer patients with brain metastasis

Aim: Breast cancer (BC) is among the most common causes of brain metastasis (BM). Brain metastasis leads to severe morbidity and mortality. Brain metastasis-related survival is not common despite all treatments. The aim of the present study is to compare the short-term or long-term surviving patients who underwent radiotherapy due to BM in our clinic regarding treatment modalities, and clinic-pathological characteristics as well as to investigate the factors that influence overall survival and progress for BM development. Materials and Methods: The data of 167 patients who were referred to radiotherapy due to BM were analyzed retrospectively. The patients were allocated to two groups: ones who survived less than, or more than, 14 months. The treatment, patient, and tumor characteristics were evaluated. Results: The frequencies of a better Karnofsky performance scores (p=0.001), her-2 positivity (p < 0.001), the presence of a single BM (p=0.048), an absence of leptomeningeal disease (p=0.033), an absence of extracranial metastasis (p=0.033) and having received systemic therapy following BM (p < 0.001) were higher in the group that survived longer. In the group that survived longer, having stage T1-2 disease and being under 40 years of age, and, in the group that survived less, receiving systemic therapy following BM development were found to be the factors effective on overall survival (OS). Conclusion: To the best of our knowledge, this is the first study to compare the prognostic features of breast cancer patients with BM who survived short-term or longer. In our single-center retrospective study, for the group that survived longer, having T1-2 stage disease and being under 40 were the independent predictive factors for OS in multi-variable analyses. Further studies are required to determine the groups that will have a longer change of survival and plan to receive more aggressive therapies.

PDF

___

1. Tai CH, Wu CC, Hwang ME, et al. Single institution validation of a modified graded prognostic assessment of patients with breast cancer brain metastases. CNS Oncol. 2018;7:25-34. 2. Crozier JA, Cornell LF, Rawal B, Perez EA. Breast cancer brain metastases: Molecularsubtype, treatment and survival. Breast Dis. 2016; 36:133-141.
3. Dayan A, Koca D, Akman T, et al. The factors that have an impact on the development of brain metastasis in the patients with breast cancer. J CancerResTher. 2012; 8:542-8.
4. Park BB, Uhm JE, Cho EY, et al. Prognostic factor analysis in patients with brain metastases from breast cancer: how can we improve the treatment outcomes? Cancer Chemother Pharmacol. 2009;63: 627-33.
5. Jeon W, Jang BS, Jeon SH, et al. Analysis of survival outcomes based on molecular subtypes in breast cancer brain metastases: A single institutional cohort. Breast J. 2018; 24:920-926.
6. Martin AM, Cagney DN, Catalano PJ, et al. Brain Metastases in Newly Diagnosed Breast Cancer: A Population-Based Study. JAMA Oncol. 2017; 3:1069-1077.
7. Witzel I, Laakmann E, Weide R, et al.Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry. Eur J Cancer. 2018;102:1-9.
8. Mills MN, Figura NB, Arrington JA, et al. Management of brain metastases in breast cancer: a review of current practices and emerging treatments. Breast Cancer Res Treat. 2020;180:279- 300.
9. Minisini AM, Moroso S, Gerratana L, et al. Risk factors and survival outcomes in patients with brain metastases from breast cancer. Clin Exp Metastasis. 2013; 30:951-6.
10. Takahashi H, Isogawa M. Management of breast cancer brain metastases. Chin Clin Oncol. 2018; 7:30.
11. Kuba S, Ishida M, Nakamura Y, et al. Treatment and prognosis of breast cancer patients with brain metastases according to intrinsic subtype. Jpn J ClinOncol. 2014; 44:1025-31.
12. Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997; 37:745-51.
13. Sperduto PW, Kased N, Roberge D, et al. Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2012; 82:2111-7.
14. Sperduto PW, Mesko S, Li J, et al. Beyond an Updated Graded PrognosticAssessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 toToday. Int J Radiat Oncol Biol Phys. 2020;107:334-343.
15. Nam BH, Kim SY, Han HS, et al. Breast cancer subtypes and survival in patients with brain metastases. Breast Cancer Res. 2008;10:R20.
16. Kofron CP, Chapman A. Breast Cancer With Brain Metastases: Perspective From a Long-Term Survivor. Integr Cancer Ther. 2020; 19: 1534735419890017.
17. Sperduto PW, Kased N, Roberge D, et al. The effect of tumor subtype on the time from primary diagnosis to development of brain metastases and survival in patients with breast cancer. J Neurooncol. 2013;112:467-72.
18. Lee SS, Ahn JH, Kim MK, et al. Brain metastases in breast cancer: prognostic factors and management. Breast Cancer Res Treat. 2008;111:523-30.
19. Nieder C, Astner ST, Andratschke NH, Adam M. Disease presentation and outcome in very young patients with brain metastases from breast cancer. Tumori. 2008; 94:691-3.
20. Hulsbergen AFC, Lamba N, Claes A, et al. Prognostic Value of Brain Metastasis-Free Interval in Patients with Breast Cancer Brain Metastases. World Neurosurg. 2019;128:e157-e164.
21. Melisko ME, Moore DH, Sneed PK, et al. Brain metastases in breast cancer: clinical and pathologic characteristics associated with improvements in survival. J Neurooncol. 2008; 88:359-65. 221