title: Local control of brain metastasis: treatment outcome of focal brain treatments in relation to subtypes.
abstract: OBJECTIVE
  To investigate treatment options for local control of metastasis in the brain, we compared focal brain treatment (FBT) with or without whole brain radiotherapy (WBRT) vs. WBRT alone, for breast cancer patients with tumor relapse in the brain. We also evaluated treatment outcomes according to the subtypes.
  
  
  METHODS
  We conducted a retrospective review of breast cancer patients with brain metastasis after primary surgery. All patients received at least one local treatment for brain metastasis. Surgery or stereotactic radiosurgery was categorized as FBT. Patients were divided into two groups: the FBT group received FBT±WBRT, whereas the non-FBT group received WBRT alone. Subtypes were defined as follows: hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HR-positive/HER2-positive, HR-negative/HER2-positive, and triple-negative (TN). We examined the overall survival after brain metastasis (OSBM), brain metastasis-specific survival (BMSS), and brain metastasis-specific progression-free survival (BMPFS).
  
  
  RESULTS
  A total of 116 patients were identified. After a median follow-up of 50.9 months, the median OSBM was 11.5 months (95% confidence interval, 9.0-14.1 months). The FBT group showed significantly superior OSBM and BMSS. However, FBT was not an independent prognostic factor for OSBM and BMSS on multivariate analyses. In contrast, multivariate analyses showed that patients who underwent surgery had improved BMPFS, indicating local control of metastasis in the brain. FBT resulted in better BMPFS in patients with HR-negative/HER2-positive cancer or the TN subtype.
  
  
  CONCLUSIONS
  We found that patients who underwent surgery experienced improved local control of brain metastasis, regardless of its extent. Furthermore, FBT showed positive results and could be considered for better local control of brain metastasis in patients with aggressive subtypes such as HER2-positive and TN.
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Uk
authors.initials: JU
authors.lastname: Chong
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sung Gwe
authors.initials: SG
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hak Min
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Tae
authors.initials: JT
authors.lastname: Park
authors.affiliation: Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
authors.forename: Seung Ah
authors.initials: SA
authors.lastname: Lee
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seho
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joon
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Kim
keywords: Brain; Breast neoplasms; Cranial irradiation; Neoplasm metastasis; Radiosurgery; Surgery
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