title: Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer. Clinical article.
abstract: OBJECTIVE
  To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival.
  
  
  METHODS
  The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19-84 years), and the median number of tumors per patient was 2 (range 1-18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm(3) (range 0.01-48.9 cm(3)), and the median total tumor volume for each patient was 4.9 cm(3) (range 0.09-74.1 cm(3)).
  
  
  RESULTS
  Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania15213, USA. kondziolkads@upmc.edu
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kano
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Harrison
authors.forename: Huai-Che
authors.initials: HC
authors.lastname: Yang
authors.forename: Donald N
authors.initials: DN
authors.lastname: Liew
authors.forename: Ajay
authors.initials: A
authors.lastname: Niranjan
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brufsky
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001929:Brain Edema / Q000517:prevention & control; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D018734:Genes, erbB-2 / Q000235:genetics; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone