Intensified local treatment and systemic therapy significantly increase survival in patients with brain metastases from advanced breast cancer - a retrospective analysis.
BACKGROUND
Brain metastases have evolved from a rare to a frequently encountered event in advanced breast cancer due to advances in palliative systemic treatment.


METHODS
All Patients treated at our centre from 1994 to 2004 with WBRT for brain metastases from breast cancer were included. We performed a multivariate analysis (Cox regression) to explore which factors are able to influence significantly cerebral time to progression (TTP) and overall survival (metastatic sites [visceral versus non-visceral], Karnofsky performance score [KPS], age, intensified local treatment [boost irradiation, neuro-surgical resection] further systemic treatment).


RESULTS
Overall 174 patients, median age 51 years, range 27-76 years, were included. Median TTP was 3 months (m), range 1-33+ m. Median overall survival was 7 m, range 1-44 m. Factors significantly influencing TTP were KPS (p = 0.002), intensified local treatment (p < 0.001), and palliative systemic treatment (p = 0.001). Factors significantly influencing survival were intensified local treatment (p = 0.004), metastatic sites (p = 0.008), KPS (p = 0.006), and palliative systemic treatment (p < 0.001).


CONCLUSIONS
As shown by the significant influence of metastatic sites, some patients die from their advanced systemic tumour situation before they would die from cerebral progression. In other individuals however, intensified local treatment and systemic treatment appear to influence cerebral time to progression and overall survival.
Bartsch
Rupert
R
Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna, Austria.
Fromm
Sabine
S
Rudas
Margaretha
M
Wenzel
Catharina
C
Harbauer
Stefanie
S
Roessler
Karl
K
Kitz
Klaus
K
Steger
Guenther G
GG
Weitmann
Hajo-Dirk
HD
Poetter
Richard
R
Zielinski
Christoph C
CC
Dieckmann
Karin
K
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome