USF-LVHN SELECT
Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases.
Publication/Presentation Date
5-1-2021
Abstract
PURPOSE: We investigated the prognostic ability of tumor subtype for patients with breast cancer brain metastases (BCBM) treated with stereotactic radiation (SRT).
METHODS: This is a retrospective review of 181 patients who underwent SRT to 664 BCBM from 2004 to 2019. Patients were stratified by subtype: hormone receptor (HR)-positive, HER2-negative (HR+/HER2-), HR-positive, HER2-positive (HR+/HER2+), HR-negative, HER2-positive (HR-/HER2+), and triple negative (TN). The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of SRT. Multivariate analysis (MVA) was conducted using the Cox proportional hazards model.
RESULTS: Median follow up from SRT was 11.4 months. Of the 181 patients, 47 (26%) were HR+/HER2+, 30 (17%) were HR-/HER2+, 60 (33%) were HR+/HER2-, and 44 (24%) were TN. Of the 664 BCBMs, 534 (80%) received single fraction stereotactic radiosurgery (SRS) with a median dose of 21 Gy (range 12-24 Gy), and 130 (20%) received fractionated stereotactic radiation therapy (FSRT), with a median dose of 25 Gy (range 12.5-35 Gy) delivered in 3 to 5 fractions. One-year LC was 90%. Two-year DIC was 35%, 23%, 27%, and 16% (log rank, p = 0.0003) and 2-year OS was 54%, 47%, 24%, and 12% (log rank, p < 0.0001) for HR+/HER2+, HR-/HER2+, HR+/HER2-, and TN subtypes, respectively. On MVA, the TN subtype predicted for inferior DIC (HR 1.62, 95% CI 1.00-2.60, p = 0.049). The modified breast-Graded Prognostic Assessment (GPA) significantly predicted DIC and OS (both p < 0.001).
CONCLUSIONS: Subtype is prognostic for OS and DIC for patients with BCBM treated with SRT.
Volume
152
Issue
3
First Page
591
Last Page
601
ISSN
1573-7373
Published In/Presented At
Mills, M. N., Thawani, C., Figura, N. B., Oliver, D. E., Soyano, A. E., Etame, A., Robinson, T. J., Liu, J. K., Vogelbaum, M. A., Forsyth, P. A., Czerniecki, B. J., Soliman, H. H., Han, H. S., Yu, H. M., & Ahmed, K. A. (2021). Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases. Journal of neuro-oncology, 152(3), 591–601. https://doi.org/10.1007/s11060-021-03735-5
Disciplines
Medical Education | Medicine and Health Sciences
PubMedID
33742358
Department(s)
USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article