Arzu AKŞAHİN, Uğur ERSOY, Dilşen ÇOLAK, Berkant SÖNMEZ, G. İnanç İMAMOĞLU, Mustafa ALTINBAŞ

Meme kanserli hastalarımızın beyin metastazı açısından retrospektif gözden geçirilmesi

Amaç: Çalışmamızda kliniğimizde meme kanseri tanısı ile takip ve tedavisi uygulanan, tanı anında veya takip sırasında beyin veya leptomeningeal metastazı tespit edilen vakaların retrospektif incelenmesi ve bu konudaki literatürün gözden geçirilmesi hedeflenmiştir. Gereç ve Yöntem: Kliniğimize başvuran meme kanserli hastaların retrospektif incelemesinde intrakranial metastazı olanların metastaz anındaki semptomları, metastazların yerleşimi, sayısı, tanı ve tedavi yöntemleri ve sağkalımları kaydedildi. Sonuçlar: Kliniğimize başvurmuş olan 220 meme kanserli hastanın retrospektif değerlendirmesinde, sekiz hastada (%3,6) beyin metastazı tespit edildi. Vakaların birinde leptomeningeal metastaz tespit edildi. Bir hastada soliter, yedi hastada multipl beyin metastazı mevcuttu. Soliter beyin metastazı olan hasta eksizyonu kabul etmemişti. Hastaların hepsine tüm beyin ışınlaması uygulandı. Leptomeningeal metastaz olan vakada daha önce beyin metastazları nedeni ile tüm beyin ışınlaması uygulanmıştı. Tekrar RT uygun görülmeyen hastada hidrosefali gelişince ventiküloperitoneal şant uygulandı. Hastalarımızın sağkalımları RPA klasifikasyonu ile uyumlu idi. Tartışma: Sistemik hastalığı kontrol altında olan, rezeke edilebilir beyin metastazlı vakalarda cerrahi tedavi gündeme gelebilir. Anrezektabl beyin metastazlı vakalarda, tüm beyin ışınlaması standart tedavidir. Halen meme kanserinde beyin metastazı sonrası sağkalım yararı gösteren kemoterapi ajanı mevcut değildir. HER2 pozitif beyin metastazlı hastalarda, retrospektif çalışmalar trastuzumabın sağkalıma belirgin katkısı olduğunu göstermiştir. Daha önce antrasiklin, taksan ve trastuzumab almış ve progresyon gözlenmiş olan beyin metastazlı vakalarda lapatinib- kapesitabin kombinasyonu da bir seçenek olabilir.

Retrospective evaluation of our breast cancer patients with intracranial metastases

Aim: In this study, we aim to evaluate our breast cancer patients with brain and/or leptomeningeal metastases retrospectively and look over the literature. Material and Method: The symptoms of patients at the time when brain metastases were diagnosed, the localization, number and treatment of metastases and the survival of the patients were recorded. Results: Of the 220 breast carcinoma patients, 8 (%3,6) were found to have brain metastases. In one of these patients leptomeningeal metastases was also detected. The brain metastases was solitary in one and multiple in seven patients. The patient with solitary brain metastases didn’t accept surgery. Whole brain radiotherapy was done to all patients. In one patient, since radiotherapy had been applied for brain metastases, additional dose was not given when leptomeningeal metastases occured. As hydrocephalia occured, ventriculoperitoneal shunt was done for this patient. The survivals of the patients were consistent with RPA classification survivals. Discussion: Surgery may be an option for the patients with solitary brain metastases if systemic malignancy is otherwise under remission. Whole brain radiotherapy is the optional treatment choice for unresectable brain metastases. Any chemotheurapeutic agent hasn’t yet been shown to be effective in prolonging survival in breast carcinoma patients with brain metastases. For HER2 positive cases, trastuzumab was shown to prolong survival significantly in some retrospective studies. Lapatinib-capecitabine combination can be an option for the cases with brain metastases who had progressed after anthracycline, taxane and trastuzumab based treatments.

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