title: Breast cancer subtype as a predictor for outcomes and control in the setting of brain metastases treated with stereotactic radiosurgery.
abstract: We investigated effects of breast cancer subtype on overall survival (OS), local and distant control, and time from initial diagnosis to brain metastases (BM). We also investigated advances in graded prognostic assessment (GPA) scores. A cohort of 72 patients treated for BM from breast cancer with Gamma Knife stereotactic radiosurgery at our institution from 2000 to 2014 had subtyping available and were used for this study. Median follow up for OS was 12 months and for control was 6 months. OS for luminal, HER2, and triple negative subtypes were 26, 20, and 22 months. OS when stratified by Sperduto et al. (J Clin Oncol 30(4):419-425, 2012) and Subbiah et al. (J Clin Oncol 33(20):2239-2245, 2015) GPAs were similar (p = 0.087 and p = 0.063). KPS and treatment modality were significant for OS (p = 0.002; p = 0.034). On univariate analysis, triple negative subtype and >3 BM were trending and significant for decreased OS (p = 0.084; p = 0.047). On multivariable analysis HER2, triple negative, and >3 BM were significant for OS (p = 0.022; p = 0.040; p = 0.009). Subtype was significant for response on a per lesion basis (p = 0.007). Subtype was trending towards significance when analyzing time from initial diagnosis to BM treatment (p = 0.064). Breast cancer subtype is an important prognostic factor when stratifying breast cancer patients with BM. The addition of number of BM to the GPA is a useful addition and should be further investigated. Subtype has an effect on lesion response, and also on rate of development BM after initial diagnosis.
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Grubb
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Jani
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Saad
authors.affiliation: The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA.
authors.forename: Yasir H
authors.initials: YH
authors.lastname: Qureshi
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Tavish
authors.initials: T
authors.lastname: Nanda
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Yaeh
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Tzlil
authors.initials: T
authors.lastname: Rozenblat
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sisti
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
authors.forename: Jeraldine
authors.initials: J
authors.lastname: Lesser
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Cheng
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.|Department of Neurological Surgery, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Isaacson
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.|Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lassman
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.|Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
authors.forename: Eileen P
authors.initials: EP
authors.lastname: Connolly
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA. tjw2117@cumc.columbia.edu.|Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. tjw2117@cumc.columbia.edu.
authors.forename: Tony J C
authors.initials: TJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001932:Brain Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016634:Radiosurgery; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D015996:Survival Rate; D064726:Triple Negative Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Brain metastases; Breast cancer; Graded prognostic assessment (GPA); Stereotactic radiosurgery; Subtype