Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer. Clinical article.
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.
Kondziolka
Douglas
D
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania15213, USA. kondziolkads@upmc.edu
Kano
Hideyuki
H
Harrison
Gillian L
GL
Yang
Huai-Che
HC
Liew
Donald N
DN
Niranjan
Ajay
A
Brufsky
Adam M
AM
Flickinger
John C
JC
Lunsford
L Dade
LD
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
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone