title: Brain metastasis in patients with metastatic breast cancer in the real world: a single-institution, retrospective review of 12-year follow-up.
abstract: The data of 589 metastatic breast cancer (MBC) patients in a single institution were reviewed to determine the outcomes of patients with brain metastasis (BM) and assess the efficacy of BM screening.
  
  
  
  The patients with BM among the 589 MBC patients who underwent treatment at Shizuoka Cancer Center (Shizuoka, Japan) from 09/2002 to 03/2014 were retrospectively analyzed.
  
  
  
  During the study period, BM developed in 187 (31.7%) patients. The tumor subtypes were as follows: luminal (hormone receptor [HR]+, HER2-), 44.9%; luminal-HER2 (HR+, HER2+), 14.9%; HER2 (HR-, HER2+), 21.3%; and triple-negative (TN), 16.0%. BM was detected in 48.6% of the patients by screening MRI. While 137 of 187 patients underwent local therapy, whole-brain irradiation was the most frequently applied therapy (63.5%). The median overall survival from the diagnosis of BM was as follows: luminal, 7.0 months (M); luminal-HER2, 13.3 M; HER2, 17.7 M; TN, 4.2 M. The HER2 status (hazard ratio [HR]: 0.58, 95% confidence interval [CI] 0.38-0.88) and nonprogressive extracranial lesion(s) (HR: 0.45, 95% CI 0.29-0.71) were identified as prognostic factors in a multivariate analysis. When limited to HER2-overexpressed MBC patients, the multivariate analysis revealed that non-progressive extracranial lesion(s) (HR: 0.20, 95% CI 0.088-0.47) and stereotactic irradiation (STI) as an initial treatment (HR: 0.18, 95% CI 0.061-0.56) were prognostic factors.
  
  
  
  Our retrospective review showed that early detection of BM by screening MRI, followed by STI, improved the prognosis of HER2-overexpressed MBC patients with BM. A further prospective randomized study is needed to confirm our findings.
authors.affiliation: Division of Breast Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Shizuoka, Japan.|Division of Breast Surgery, Tokyo Medical College, Hachioji Medical Center, Tokyo, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Division of Breast Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Shizuoka, Japan. j.watanabe@scchr.jp.
authors.forename: Junichiro
authors.identifier: 0000-0001-9226-895X
authors.initials: J
authors.lastname: Watanabe
authors.affiliation: Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Mitsuya
authors.affiliation: Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Nakamasa
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Division of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nakasu
authors.affiliation: Division of Breast Surgery, Tokyo Medical College, Hachioji Medical Center, Tokyo, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Brain metastasis; Breast cancer; HER2; Prospective screening