Introduction
Methods
Study population and patient characteristics
Outcome information
Statistical analyses
Results
Clinical characteristics of the cohort
Characteristics | Patients | % |
---|---|---|
At the time of WBRT |
N
| |
Age (years) | ||
30–49 | 67 | 28 |
50–69 | 137 | 57 |
70+ | 37 | 15 |
Median (range) | 58 (30–88) | |
Calendar year | ||
1999–2001 | 38 | 16 |
2002–2004 | 29 | 12 |
2005–2007 | 47 | 19 |
2008–2010 | 74 | 31 |
2011–2012 | 53 | 22 |
No of brain metastases | ||
1–3 (size 5–55 mm) | 33 | 14 |
4–6 | 26 | 11 |
7–9 | 11 | 5 |
Massive | 116 | 48 |
Leptomeningeal | 53 | 22 |
Missing | 2 | 1 |
Time between diagnosis of breast cancer and WBRT | ||
0–3 years | 94 | 9 |
3–6 years | 72 | 30 |
>6 years | 75 | 31 |
WBRT dose | ||
4 Gy × 5 | 212 | 88 |
3 Gy × 10 | 27 | 12 |
2 Gy × 20 | 1 | 0 |
Missing | 1 | 0 |
WBRT completion | ||
Yes | 228 | 95 |
No | 13 | 5 |
Other metastases | ||
Only brain | 60 | 25 |
Brain + viscerala
| 51 | 21 |
Brain + non visceralb
| 45 | 19 |
Brain + multiple | 85 | 35 |
WHO performance status score | ||
0–1 | 128 | 53 |
2 | 71 | 29 |
3–4 | 41 | 17 |
Missing | 1 | 0 |
Family situation | ||
Married/cohabitation | 96 | 40 |
Married/cohabitation, w/children | 70 | 29 |
Alone, w/children | 12 | 5 |
Alone | 62 | 26 |
Missing | 1 | 0 |
Level of care (1 week before WBRT) | ||
Home | 145 | 60 |
Hospital | 88 | 37 |
Palliative inpatient care | 8 | 3 |
At primary breast cancer diagnosis | ||
Stage | ||
1 | 44 | 21 |
2 | 108 | 50 |
3 | 40 | 19 |
4 | 22 | 10 |
ER | ||
ER+ | 135 | 56 |
ER− | 104 | 43 |
Missing ER | 2 | 1 |
HER2 | ||
HER2+ | 79 | 33 |
HER2− | 110 | 46 |
Missing HER2 | 52 | 22 |
Subtype | ||
Luminal A | 65 | 27 |
Luminal B | 36 | 15 |
HER2 type | 43 | 18 |
Triple negative | 45 | 19 |
Missing | 52 | 22 |
Palliative treatments before WBRT | ||
No of palliative chemotherapy regimens | ||
Median (range) | 2 (0–9) | |
Missing | 5 | 2 |
Palliative endocrine therapy | ||
No | 150 | 62 |
Yes | 82 | 34 |
Palliative trastuzumab | ||
No | 172 | 71 |
Yes | 60 | 25 |
Missing | 9 | 4 |
Brain metastases and WBRT
Overall survival
Characteristics | Median survival months (range) | Adjusted HRa
(95% CI) | Adjusted HRb
(95% CI) |
---|---|---|---|
At the time of WBRT | |||
Age (years) | |||
30–49 | 4.1 (0.2–86.8) | 1.0 (ref) | 1.0 (ref) |
50–69 | 2.6 (0–40.6) |
1.36 (1.01–1.84)
| 1.13 (0.83–1.54) |
70+ | 2.3 (0.1–32.6) |
1.73 (1.15–2.60)
| 1.28 (0.84–1.94) |
Calendar year | |||
1999–2001 | 1.6 (0.17–32.6) |
1.85 (1.20–2.86)
|
1.91 (1.23–2.96)
|
2002–2004 | 4.8 (0.4–86.8) | 1.07 (0.67–1.71) | 1.06 (0.66–1.70) |
2005–2007 | 3.0 (0–23.0) | 1.26 (0.85–1.88) | 1.32 (0.88–1.97) |
2008–2010 | 3.1 (0.1–41.1) | 1.25 (0.87–1.80) | 1.15 (0.80–1.67) |
2011–2012 | 2.8 (0.1–35.4) | 1.0 (ref) | 1.0 (ref) |
No of brain metastases | |||
1–3 (Size 5–55 mm) | 2.5 (0.2–36.2) | 1.04 (0.67–1.64) | 1.08 (0.68–1.72) |
4–6 | 2.5 (0.3–11.8) | 1.33 (0.82–2.15) | 1.60 (0.98–2.62) |
7–9 | 3.1 (0.6–12.4) | 1.22 (0.63–2.38) | 1.46 (0.74–2.88) |
Massive | 3.0 (0.1–86.8) | 0.94 (0.67–1.33) | 1.13 (0.80–1.60) |
Leptomeningeal | 2.5 (0–35.4) | 1.0 (ref) | 1.0 (ref) |
Time between diagnosis and WBRT | |||
0–3 years | 2.1 (0–36.2) |
1.62 (1.17–2.24)
|
1.51 (1.09–2.10)
|
3–6 years | 3.5 (0.2–41.1) |
1.47 (1.04–2.08)
| 1.24 (0.88–1.76) |
>6 years | 3.6 (0.1–86.8) | 1.0 (ref) | 1.0 (ref) |
WBRT dose | |||
4 Gy × 5 | 2.6 (0–86.8) | 1.0 (ref) | 1.0 (ref) |
3 Gy × 10 | 4.1 (0.2–32.6) | 0.73 (0.47–1.13) | 0.73 (0.47–1.14) |
Other metastases | |||
Only brain | 3.7 (0–86.8) | 1.0 (ref) | 1.0 (ref) |
Brain + visceralc
| 2.8 (0.1–21.6) | 1.16 (0.78–1–71) | 1.11 (0.74–1.67) |
Brain + non viscerald
| 4.1 (0.1–32.6) | 0.96 (0.64–1.43) | 1.04 (0.70–1.56) |
Brain + multiple | 2.5 (0.13–41.1) |
1.59 (1.11–2.27)
| 1.37 (0.96–1.94) |
WHO performance status score | |||
0–1 | 5.5 (0.4–86.8) | 1.0 (ref) | –– |
2 | 2.0 (0.1–16.5) |
2.78 (2.01–3.84)
| |
3–4 | 0.9 (0–5.5) |
5.96 (3.88–9.17)
| |
Family situation | |||
Married/cohabitation | 2.4 (0.1–32.6) | 1.22 (0.87–1.73) | 1.34 (0.95–1.88) |
Married/cohabitation w/children | 3.2 (0–86.8) | 1.11 (0.73–1.70) | 1.06 (0.69–1.62) |
Alone w/children | 8.2 (0.2–41.1) | 0.64 (0.33–1.25) | 0.85 (0.43–1.68) |
Alone | 3.1 (0.1–40.6) | 1.0 (ref) | 1.0 (ref) |
Level of care (one week before WBRT) | |||
Home | 4.1 (0.1–86.8) | 1.0 (ref) | 1.0 (ref) |
Hospital | 2.0 (0–40.6) |
1.53 (1.16–2.04)
| 1.03 (0.75–1.40) |
Palliative inpatient care | 2.5 (0.3–3.7) |
2.60 (1.24–5.45)
| 1.11 (0.51–2.42) |
At primary breast cancer diagnosis | |||
Stage | |||
1 | 4.0 (0.1–86.8) | 1.0 (ref) | 1.0 (ref) |
2 | 2.5 (0–40.6) | 1.21 (0.84–1.73) | 1.18 (0.81–1.70) |
3 | 2.6 (0.2–41.1) | 1.40 (0.90–2.18) | 1.52 (0.97–2.37) |
4 | 1.6 (0.3–21.6) | 1.62 (0.96–2.76) | 1.38 (0.81–2.37) |
ER | |||
ER+ | 3.4 (0–86–8) | 1.0(ref) | 1.0 (ref) |
ER− | 2.6 (0.2–35.4) |
1.35 (1.03–1.77)
|
1.33 (1.01–1.77)
|
HER2 | |||
HER2+ | 4.2 (0.1–86.8) | 1.0 (ref) | 1.0 (ref) |
HER2− | 2.5 (0–41.1) | 1.28 (0.94–1.75) | 1.27 (0.92–1.75) |
Subtype | |||
Luminal A | 3.5 (0–41.1) | 1.0 (ref) | 1.0 (ref) |
Luminal B | 3.9 (0.1–86.8) | 0.94 (0.62–1.44) | 0.99 (0.64–1.52) |
HER2 type | 4.1 (0.2–21.6) | 1.04 (0.68–1.57) | 1.04 (0.68–1.61) |
Triple negative | 2.0 (0.2–35.4) |
1.87 (1.25–2.80)
|
1.87 (1.23–2.84)
|
Palliative treatments before WBRT | |||
Palliative trastuzumab | |||
Yes | 5.0 (0.1–86.8) | 1.0 (ref) | 1.0 (ref) |
No | 2.4 (0–41.1) |
1.40 (1.03–1.90)
|
1.37 (1.01–1.86)
|
No of palliative chemotherapy regimens | |||
0 | 1.6 (0–40.6) | 1.0 (ref) | 1.0 (ref) |
1+ | 3.5 (0.1–86.8) |
0.61 (0.44–0.85)
|
0.65 (0.46–0.92)
|
Level of care after WBRT
Ever at home after WBRT | Total | ||
---|---|---|---|
Yes | No | ||
Total | 184 (76) | 57 (24) | 241 (100%) |
Level of care before WBRT | |||
Home | 133 (92%) | 12 (8%) | 145 (100%) |
Hospital/Palliative inpatient care | 51 (53%) | 45 (47%) | 96 (100%) |
WHO performance status score one week before WBRT | |||
0–1 | 124 (97%) | 4 (3%) | 128 (100%) |
2 | 46 (65%) | 25 (35%) | 71 (100%) |
3–4 | 14 (34%) | 27 (66%) | 41 (100%) |
Characteristics |
N (%) of patients not coming home | Adjusted ORa (95% CI) | Adjusted ORb (95% CI) |
---|---|---|---|
At the time of WBRT | |||
Age (years) | |||
30–49 | 6 (9) | 1.0 (ref) | 1.0 (ref) |
50–69 | 37 (27) |
3.76 (1.48–9.53)
| 2.60 (0.84–8.08) |
70+ | 14 (38) |
6.45 (2.16–19.2)
| 3.36 (0.91–13.18) |
Calendar year | |||
1999–2006 | 21 (21) | 1.0 (ref) | 1.0 (ref) |
2007–2012 | 36 (26) | 1.06 (0.55–2.03) | 1.07 (0.49–2.38) |
No of brain metastases | |||
1–3 (Size 5–55 mm) | 8 (24) | 1.0 (ref) | 1.0 (ref) |
4–6 | 8 (30) | 1.72 (0.48–6.12) | 2.44 (0.50–12.1) |
7–9 | 2 (18) | 0.73 (0.13–4.56) | 1.40 (0.18–11.0) |
Massive | 26 (22) | 1.19 (0.43–3.27) | 1.57 (0.47–5.18) |
Leptomeningeal | 13 (25) | 1.26 (0.42–3.80) | 1.21 (0.33–4.37) |
Time between diagnosis and WBRT | |||
0–3 years | 30 (32) | 1.0 (ref) | 1.0 (ref) |
3–6 years | 12 (17) | 0.45 (0.20–1.00) | 0.54 (0.20–1.44) |
>6 years | 15 (20) |
0.43 (0.20–0.93)
| 0.47 (0.19–1.17) |
WBRT dose | |||
4 Gy × 5 | 51 (24) | 1.0 (ref) | 1.0 (ref) |
3 Gy × 10 | 6 (22) | 1.19 (0.43–2.30) | 1.54 (0.43–5.46) |
Other metastases | |||
Only brain | 14 (23) | 1.0 (ref) | 1.0 (ref) |
Brain + visceralc
| 9 (18) | 0.75 (0.27–2.03) | 0.66 (0.20–2.21) |
Brain + non viscerald
| 11 (24) | 1.20 (0.46–3.11) | 1.82 (0.53–6.24) |
Brain + multiple | 23 (27) | 1.85 (0.80–4.26) | 1.24 (0.46–3.34) |
WHO performance status score | |||
0–1 | 4 (3) | 1.0 (ref) | – |
2 | 25 (35) |
16.9 (5.39–53.1)
| – |
3–4 | 27 (66) |
54.5 (15.7–189)
| – |
Family situation | |||
Married/cohabitation | 25 (26) | 0.63 (0.30–1–31) | 0.54 (0.22–1.37) |
Married/cohabitation w/children | 8 (11) | 0.38 (0.13–1–09) |
0.21 (0.06–0.78)
|
Alone w/children | 1(8) | 0.22 (0.02–1.97) | 1.27 (0.11–14.97) |
Alone | 23 (37) | 1.0 (ref) | 1.0 (ref) |
Level of care (1 week before WBRT) | |||
Home | 12 (8) | 1.0 (ref) | 1.0 (ref) |
Hospital | 40 (45) |
10.2 (4.63–22.4)
|
5.20 (2.12–12.7)
|
Palliative inpatient care | 4 (63) |
21.2 (4.03–111)
| 5.27 (0.89–31.06) |
At primary breast cancer diagnosis | |||
ER | |||
ER+ | 31 (23) | 1.0 (ref) | 1.0 (ref) |
ER− | 26 (25) | 1.11 (0.57–2.14) | 1.19 (0.52–2.74) |
HER2 | |||
HER2+ | 14 (18) | 1.0 (ref) | 1.0 (ref) |
HER2− | 31 (28) | 2.04 (0.93–4.49) | 1.97 (0.70–5.54) |
Subtype | |||
Luminal A | 12 (18) | 1.0 (ref) | 1.0 (ref) |
Luminal B | 10 (28) | 1.69 (0.60–4.80) | 2.66 (0.66–10.72) |
HER2 type | 4 (9) | 0.36 (0.10–1.30) | 0.39 (0.09–1.80) |
Triple negative | 19 (42) |
2.57 (1.02–6.50)
| 2.85 (0.89–9.15) |
Palliative treatments before WBRT | |||
Palliative trastuzumab | |||
Yes | 10 (17) | 0.63 (0.28–1.40) | 0.68 (0.25–1.90) |
No | 46 (27) | 1.0 (ref) | 1.0 (ref) |
No of palliative chemotherapy regimens | |||
0 | 22 (42) | 1.0 (ref) | 1.0 (ref) |
1+ | 35 (19) |
0.42 (20–0.85)
| 0.50 (0.21–1.19) |