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Erschienen in: Breast Cancer Research and Treatment 1/2012

01.11.2012 | Clinical Trial

Brain metastases after breast-conserving therapy and systemic therapy: incidence and characteristics by biologic subtype

verfasst von: Nils D. Arvold, Kevin S. Oh, Andrzej Niemierko, Alphonse G. Taghian, Nancy U. Lin, Rita F. Abi-Raad, Meera Sreedhara, Jay R. Harris, Brian M. Alexander

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 1/2012

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Abstract

The characteristics of brain metastases (BM) that develop after breast-conserving therapy (BCT) for early-stage breast cancer (BC) remain incompletely defined. We examined 1,434 consecutive patients with stage I/II invasive BC who received BCT from 1997 to 2006, 91 % of whom received adjuvant systemic therapy, according to BC subtype. Median follow-up was 85 months. Overall 5-year cumulative incidence of BM was 1.7 %; 0.1 % for luminal A, 3.3 % for luminal B, 3.2 % for luminal-HER2, 3.7 % for HER2, and 7.4 % for triple negative (TN). Women who developed BM were more likely at BC diagnosis to be younger (P < .0001) and have node-positive (P < .0001), grade 3 (P < .0001), hormone receptor-negative (P = .006), and HER2-positive (P = .01) tumors. Median time from BC diagnosis to BM was 51.4 months (range, 7.6–108 months), which was longer among luminal versus non-luminal subtypes (P = .0002; median, 61.4 vs. 34.5 months). Thirty-four percent of patients who developed distant metastases (DM) eventually developed BM. Median time from DM to BM was 12.8 months but varied by subtype, including 7.4 months for TN, 9.6 months for luminal B, and 27.1 months for HER2. Eighty-one percent of all BM patients presented with neurologic symptoms. Median number of BM at diagnosis was two, and median BM size was 15 mm, with TN (27 mm) and luminal B (16 mm) exhibiting the largest median sizes. In conclusion, the risk of BM after BCT varies significantly by subtype. Given the large size and symptomatic presentation among luminal B and TN subtypes, earlier BM detection might improve quality of life or increase eligibility for non-invasive treatments including stereotactic radiosurgery. Women with DM from these two BC subtypes have a high incidence of BM with a short latency, suggesting an ideal target population for trials evaluating the utility of MRI screening.
Literatur
1.
Zurück zum Zitat Anderson SJ, Wapnir I, Dignam JJ et al (2009) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol 27:2466–2473PubMedCrossRef Anderson SJ, Wapnir I, Dignam JJ et al (2009) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol 27:2466–2473PubMedCrossRef
2.
Zurück zum Zitat Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 365:1687–1717CrossRef Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 365:1687–1717CrossRef
3.
Zurück zum Zitat Lin NU, Bellon JR, Winer EP (2004) CNS metastases in breast cancer. J Clin Oncol 22:3608–3617PubMedCrossRef Lin NU, Bellon JR, Winer EP (2004) CNS metastases in breast cancer. J Clin Oncol 22:3608–3617PubMedCrossRef
4.
Zurück zum Zitat Crivellari D, Pagani O, Veronesi A et al (2001) High incidence of central nervous system involvement in patients with metastatic or locally advanced breast cancer treated with epirubicin and docetaxel. Ann Oncol 12:353–356PubMedCrossRef Crivellari D, Pagani O, Veronesi A et al (2001) High incidence of central nervous system involvement in patients with metastatic or locally advanced breast cancer treated with epirubicin and docetaxel. Ann Oncol 12:353–356PubMedCrossRef
5.
Zurück zum Zitat Burstein GJ, Lieberman G, Slamon DJ, Winer EP, Klein P (2005) Isolated central nervous system metastases in patients with HER2-overexpressing advanced breast cancer treated with first-line trastuzumab-based therapy. Ann Oncol 16:1772–1777PubMedCrossRef Burstein GJ, Lieberman G, Slamon DJ, Winer EP, Klein P (2005) Isolated central nervous system metastases in patients with HER2-overexpressing advanced breast cancer treated with first-line trastuzumab-based therapy. Ann Oncol 16:1772–1777PubMedCrossRef
6.
Zurück zum Zitat Barnholtz-Sloan JS, Sloan AE, Davis FG et al (2004) Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 22:2865–2872PubMedCrossRef Barnholtz-Sloan JS, Sloan AE, Davis FG et al (2004) Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 22:2865–2872PubMedCrossRef
7.
Zurück zum Zitat Nam BH, Kim SY, Han HS et al (2008) Breast cancer subtypes and survival in patients with brain metastases. Breast Cancer Res 10:R20PubMedCrossRef Nam BH, Kim SY, Han HS et al (2008) Breast cancer subtypes and survival in patients with brain metastases. Breast Cancer Res 10:R20PubMedCrossRef
8.
Zurück zum Zitat Niwinska A, Murawska M, Pogoda K (2010) Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). Ann Oncol 21:942–948PubMedCrossRef Niwinska A, Murawska M, Pogoda K (2010) Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). Ann Oncol 21:942–948PubMedCrossRef
9.
Zurück zum Zitat Lin NU, Claus E, Sohl J et al (2008) Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases. Cancer 113:2638–2645PubMedCrossRef Lin NU, Claus E, Sohl J et al (2008) Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases. Cancer 113:2638–2645PubMedCrossRef
10.
Zurück zum Zitat Kennecke H, Yerushalmi R, Woods R et al (2010) Metastatic behavior of breast cancer subtypes. J Clin Oncol 28:3271–3277PubMedCrossRef Kennecke H, Yerushalmi R, Woods R et al (2010) Metastatic behavior of breast cancer subtypes. J Clin Oncol 28:3271–3277PubMedCrossRef
11.
Zurück zum Zitat Harrell JC, Prat A, Parker JS et al (2012) Genomic analysis identifies unique signatures predictive of brain, lung, and liver relapse. Breast Cancer Res Treat 132:523–535PubMedCrossRef Harrell JC, Prat A, Parker JS et al (2012) Genomic analysis identifies unique signatures predictive of brain, lung, and liver relapse. Breast Cancer Res Treat 132:523–535PubMedCrossRef
12.
Zurück zum Zitat Cheang MC, Chia SK, Voduc D et al (2009) Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst 101:736–750PubMedCrossRef Cheang MC, Chia SK, Voduc D et al (2009) Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst 101:736–750PubMedCrossRef
13.
Zurück zum Zitat Arvold ND, Taghian AG, Niemierko A et al (2011) Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol 29:3885–3891PubMedCrossRef Arvold ND, Taghian AG, Niemierko A et al (2011) Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol 29:3885–3891PubMedCrossRef
14.
Zurück zum Zitat Gray RJ (1988) A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154CrossRef Gray RJ (1988) A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154CrossRef
15.
Zurück zum Zitat Lin NU, Vanderplas A, Hughes ME et al (2012) Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer. doi:10.1002/cncr.27581 Lin NU, Vanderplas A, Hughes ME et al (2012) Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer. doi:10.​1002/​cncr.​27581
16.
Zurück zum Zitat Leyland-Jones B (2009) Human epidermal growth factor receptor 2-positive breast cancer and central nervous system metastases. J Clin Oncol 27:5278–5286PubMedCrossRef Leyland-Jones B (2009) Human epidermal growth factor receptor 2-positive breast cancer and central nervous system metastases. J Clin Oncol 27:5278–5286PubMedCrossRef
17.
Zurück zum Zitat Niwinska A, Tacikowska M, Murawska M (2010) The effect of early detection of occult brain metastases in HER2-positive breast cancer patients on survival and cause of death. Int J Radiat Oncol Biol Phys 77:1134–1139PubMedCrossRef Niwinska A, Tacikowska M, Murawska M (2010) The effect of early detection of occult brain metastases in HER2-positive breast cancer patients on survival and cause of death. Int J Radiat Oncol Biol Phys 77:1134–1139PubMedCrossRef
18.
Zurück zum Zitat Miller KD, Weathers T, Haney LG et al (2003) Occult central nervous system involvement in patients with metastatic beeast cancer: prevalence, predictive factors and impact on overall survival. Ann Oncol 14:1072–1077PubMedCrossRef Miller KD, Weathers T, Haney LG et al (2003) Occult central nervous system involvement in patients with metastatic beeast cancer: prevalence, predictive factors and impact on overall survival. Ann Oncol 14:1072–1077PubMedCrossRef
19.
Zurück zum Zitat Borgelt B, Gelber R, Kramer S et al (1980) The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 6:1–9PubMedCrossRef Borgelt B, Gelber R, Kramer S et al (1980) The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 6:1–9PubMedCrossRef
20.
Zurück zum Zitat Tsao M, Zu W, Sahgal A (2012) A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer 118:2486–2493PubMedCrossRef Tsao M, Zu W, Sahgal A (2012) A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer 118:2486–2493PubMedCrossRef
21.
Zurück zum Zitat Sperduto PW, Kased N, Roberge D et al (2012) Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys 82:2111–2117PubMedCrossRef Sperduto PW, Kased N, Roberge D et al (2012) Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys 82:2111–2117PubMedCrossRef
Metadaten
Titel
Brain metastases after breast-conserving therapy and systemic therapy: incidence and characteristics by biologic subtype
verfasst von
Nils D. Arvold
Kevin S. Oh
Andrzej Niemierko
Alphonse G. Taghian
Nancy U. Lin
Rita F. Abi-Raad
Meera Sreedhara
Jay R. Harris
Brian M. Alexander
Publikationsdatum
01.11.2012
Verlag
Springer US
Erschienen in
Breast Cancer Research and Treatment / Ausgabe 1/2012
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-012-2243-x

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