Capecitabine and stereotactic radiation in the management of breast cancer brain metastases.

Authors

Matthew N Mills
Afrin Naz
Chetna Thawani
Chelsea Walker
Nicholas B Figura
Sergiy Kushchayev
Daniel E Oliver
Arnold B Etame
Hsiang-Hsuan Michael Yu
Timothy J Robinson
James K C Liu
Michael A Vogelbaum
Peter A Forsyth
Brian J Czerniecki
Hatem H Soliman
Hyo S Han
Kamran A Ahmed

Publication/Presentation Date

5-15-2021

Abstract

BACKGROUND: Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM).

METHODS: Twenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist.

RESULTS: Median follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR-/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15-24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24-30 Gy) in a median of 5 fractions (range: 3-5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively.

CONCLUSIONS: In our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.

Volume

21

Issue

1

First Page

552

Last Page

552

ISSN

1471-2407

Published In/Presented At

Mills, M. N., Naz, A., Thawani, C., Walker, C., Figura, N. B., Kushchayev, S., Oliver, D. E., Etame, A. B., Yu, H. M., Robinson, T. J., Liu, J. K. C., Vogelbaum, M. A., Forsyth, P. A., Czerniecki, B. J., Soliman, H. H., Han, H. S., & Ahmed, K. A. (2021). Capecitabine and stereotactic radiation in the management of breast cancer brain metastases. BMC cancer, 21(1), 552. https://doi.org/10.1186/s12885-021-08302-9

Disciplines

Medical Education | Medicine and Health Sciences

PubMedID

33992087

Department(s)

USF-LVHN SELECT Program, USF-LVHN SELECT Program Students

Document Type

Article