Brain metastases from breast carcinoma: validation of the radiation therapy oncology group recursive partitioning analysis classification and proposition of a new prognostic score.
OBJECTIVE
To validate the Radiation Therapy Oncology Group Recursive Partitioning Analysis (RTOG RPA) classification and determine independent prognostic factors, to create a simple and specific prognostic score for patients with brain metastases (BM) from breast carcinoma treated with whole-brain radiotherapy (WBRT).


METHODS
From January 1998 through December 2003, 132 patients with BM from breast carcinoma were treated with WBRT. We analyzed several potential predictors of survival after WBRT: age, Karnofsky performance status, RTOG-RPA class, number of BM, presence and site of other systemic metastases, interval between primary tumor and BM, tumor hormone receptor (HR) status, lymphocyte count, and HER-2 overexpression.


RESULTS
A total of 117 patients received exclusive WBRT and were analyzed. Median survival with BM was 5 months. One-year and 2-year survival rates were 27.6% (95% confidence interval [CI] 19.9-36.8%) and 12% (95% CI 6.5-21.2%), respectively. In multivariate analysis, RTOG RPA Class III, lymphopenia (< or =0.7 x 10(9)/L) and HR negative status were independent prognostic factors for poor survival. We constructed a three-factor prognostic scoring system that predicts 6-month and 1-year rates of overall survival in the range of 76.1-29.5% (p = 0.00033) and 60.9-15.9% (p = 0.0011), respectively, with median survival of 15 months, 5 months, or 3 months for patients with none, one, or more than one adverse prognostic factor(s), respectively.


CONCLUSIONS
This study confirms the prognostic value of the RTOG RPA classification, lymphopenia, and tumor HR status, which can be used to form a prognostic score for patients with BM from breast carcinoma.
Le Scodan
Romuald
R
Department of Radiation Oncology, Centre René Huguenin, Saint Cloud, France. lescodan@crh1.org
Massard
Christophe
C
Mouret-Fourme
Emmanuelle
E
Guinebretierre
Jean Marc
JM
Cohen-Solal
Christine
C
De Lalande
Brigitte
B
Moisson
Patricia
P
Breton-Callu
Christelle
C
Gardner
Miriam
M
Goupil
Alain
A
Renody
Nicole
N
Floiras
Jean Louis
JL
Labib
Alain
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000737:chemistry; D016001:Confidence Intervals; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008231:Lymphopenia / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate
D018719:Erb-b2 Receptor Tyrosine Kinases