title: Brain metastases from breast carcinoma: validation of the radiation therapy oncology group recursive partitioning analysis classification and proposition of a new prognostic score.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Centre René Huguenin, Saint Cloud, France. lescodan@crh1.org
authors.forename: Romuald
authors.initials: R
authors.lastname: Le Scodan
authors.forename: Christophe
authors.initials: C
authors.lastname: Massard
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mouret-Fourme
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Guinebretierre
authors.forename: Christine
authors.initials: C
authors.lastname: Cohen-Solal
authors.forename: Brigitte
authors.initials: B
authors.lastname: De Lalande
authors.forename: Patricia
authors.initials: P
authors.lastname: Moisson
authors.forename: Christelle
authors.initials: C
authors.lastname: Breton-Callu
authors.forename: Miriam
authors.initials: M
authors.lastname: Gardner
authors.forename: Alain
authors.initials: A
authors.lastname: Goupil
authors.forename: Nicole
authors.initials: N
authors.lastname: Renody
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Floiras
authors.forename: Alain
authors.initials: A
authors.lastname: Labib
mesh_terms: 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
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases