Gamma Knife radiosurgery for brain metastases from primary breast cancer.
OBJECTIVE
The relative roles of stereotactic radiosurgery (SRS) vs. whole brain radiotherapy (WBRT) in the treatment of patients with brain metastases from breast cancer remain undefined. In this study, we reviewed our experience with these patients.


METHODS
We retrospectively reviewed all patients treated between 1991 and 2005 with Gamma Knife SRS for brain metastases from breast cancer. The actuarial survival and freedom from progression endpoints were calculated using the Kaplan-Meier method.


RESULTS
Between 1991 and 2005, 176 patients underwent SRS for brain metastases from breast cancer. The median survival time was 16.0 months for 95 newly diagnosed patients and 11.7 months for 81 patients with recurrent brain metastases. In the newly diagnosed patients, omission of upfront WBRT did not significantly affect the MST (p = .20), brain freedom from progression (p = .75), or freedom from new brain metastases (p = .83). Longer survival was associated with age <50 years, Karnofsky performance score >or=70, primary tumor control, estrogen receptor positivity, and Her2/neu overexpression. No association was found between the number of treated brain metastases and the survival time.


CONCLUSIONS
We have described prognostic factors for breast cancer patients treated with SRS for newly diagnosed or recurrent brain metastases. Most patient subsets had a median survival time of >or=11 months. Unexpectedly, upfront WBRT did not appear to improve brain freedom from progression, and a larger number of brain metastases was not associated with a shorter survival time. Breast cancer might be distinct from other primary sites in terms of prognostic factors and the roles of WBRT and SRS for brain metastases.
Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA 94143-0226, USA. Norbert.Kased@ucsf.edu
Norbert
N
Kased
Devin K
DK
Binder
Michael W
MW
McDermott
Jean L
JL
Nakamura
Kim
K
Huang
Mitchel S
MS
Berger
William M
WM
Wara
Penny K
PK
Sneed
D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms; D016371:Cranial Irradiation / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015999:Multivariate Analysis; D009363:Neoplasm Proteins / Q000378:metabolism; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D012189:Retrospective Studies; D012495:San Francisco
D009363:Neoplasm Proteins; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen