title: Is early recognition of radiologically silent brain metastasis from breast cancer beneficial? A retrospective study of 22 cases.
abstract: Over a period of 10 years, twenty-two patients with T2-3N2Mx breast cancer presented with symptoms of increased intracranial pressure (ICP), but brain CT scan and/or MRI did not reveal any signs of a space occupying lesion. A brain CT scan and an MRI study were performed every 15 days. Ten patients refused this close follow up. Thus, two groups were formed group A (n = 12) included the patients who were close's followed and group B (n = 10) consisted of those patients who were not. Therefore, Group A, being under careful follow-up, initiated radiotherapy were quickly. The median time from the presentation of increased ICP symptoms until the appearance of metastases on CT and/or MRI directly followed by brain irradiation was 48 days (SE = 6.1) for group A and 72 days (SE = 0.7) for group B (p = 0.0085, log-rank test). In group A, median Overall Survival (OS) was 171.0 (SE = 21.5) days, and was 99.0 (SE = 6.3) days (p = 0.014) for group B. Volumetric analysis of the secondary brain lesions at the initiation of radiotherapy showed a total volume of metastatic lesions of 19.5 +/- 13.9 cm3 versus 65.3 +/- 20.7 cm3 for groups A and B, respectively (p < 0.001, Mann-Whitney test). Post-radiotherapy, Karnofsky Performance Status and Visual Analogue Score were also improved for group A versus B (p = 0.002). Group A appeared to benefit from close follow-up since the metastases were detected and irradiation was given sooner compared with group B, thus achieving better performance status and prolonged survival. Radiologically silent brain metastases from breast cancer should not be ignored because timely whole brain irradiation should be the goal of clinicians. Clinical suspicion should lead to close follow-up with multiple CT/MRI studies and cerebral spinal fluid cytology until the final diagnosis.
authors.affiliation: Palliative Unit, Department of Radiology, Areteion Hospital, Medical School, University of Athens, Greece.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Mystakidou
authors.forename: Vassilis
authors.initials: V
authors.lastname: Kouloulias
authors.forename: Eleni
authors.initials: E
authors.lastname: Tsilika
authors.forename: Efstathios
authors.initials: E
authors.lastname: Boviatsis
authors.forename: John
authors.initials: J
authors.lastname: Kouvaris
authors.forename: George
authors.initials: G
authors.lastname: Matsopoulos
authors.forename: Lambros
authors.initials: L
authors.lastname: Vlahos
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed