title: Identification of patients who may benefit from the prophylactic cranial radiotherapy among breast cancer patients with brain metastasis.
abstract: BACKGROUND
  To identify the candidates for prophylactic cranial radiotherapy (PCI) among the patients with early and advanced-stage breast cancer.
  
  
  METHODS
  The demographic, pathologic and clinical features and survival results of 182 brain metastatic breast cancer patients treated with cranial radiotherapy were examined.
  
  
  RESULTS
  Early stage patients who progressed with isolated brain metastasis had longer survival (13 months vs. 4 months P = 0.006). Lobular/mixed type histology (P = 0.033), high nuclear (P = 0.046) and high histological grade (P = 0.034) were the prognostic factors for isolated brain metastases. The most significant factor for the time to brain metastasis was the number of involved of lymph nodes (P = 0.004). In 60% of 148 patients with metastatic breast cancer, a progression with isolated brain metastasis was developed while the systemic disease was under control. Isolated brain metastasis progression was related to the presence of the hepatic metastasis at the first relapse (P = 0.001) and with ErbB-2 overexpression (P = 0.034). The time to the brain metastasis from the first extracerabral metastasis was associated with the high nuclear grade (P = 0.040) and with chemoresistance (P = 0.037). The median survival time after the brain metastases in chemosensitive patients was longer than in chemoresistant patients (8 months vs. 3 months P = 0.044). In chemoresistant patients (P = 0.0028) and/or in triple negative patients (P = 0.05) the development of the brain metastasis was early and the survival after brain metastasis was short.
  
  
  CONCLUSIONS
  Since there is a tendency to early brain metastasis in early stage patients with high-grade, lobular/mixed type histology tumors and with a high number of involved lymph nodes, the value of PCI can be explored in these patients by a well designed prospective trial. Advanced stage chemosensitive patients with ErbB-2 over-expression and/or with hepatic metastasis at their first relapse may be candidates for PCI. There is no place for PCI in chemoresistant and triple-negative breast cancer patients.
authors.affiliation: Department of Medical Oncology, Institute of Oncology, Istanbul University, Turkey.
authors.forename: Pinar
authors.initials: P
authors.lastname: Saip
authors.forename: Irfan
authors.initials: I
authors.lastname: Cicin
authors.forename: Yesim
authors.initials: Y
authors.lastname: Eralp
authors.forename: Hakan
authors.initials: H
authors.lastname: Karagol
authors.forename: Seden
authors.initials: S
authors.lastname: Kucucuk
authors.forename: Ruşen
authors.initials: R
authors.lastname: Cosar Alas
authors.forename: Ekrem
authors.initials: E
authors.lastname: Yavuz
authors.forename: Maktav
authors.initials: M
authors.lastname: Dincer
authors.forename: Esra
authors.initials: E
authors.lastname: Saglam
authors.forename: Erkan
authors.initials: E
authors.lastname: Topuz
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D017698:Postmenopause; D017697:Premenopause; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult