Background Brain metastases (BM) occur in approximately 10-30% of patients with breast cancer (BC). Patients with advanced breast cancer are living longer, and the incidence of BM are increasing. Stereotactic Radiosurgery (SRS) has emerged as a strategy to treat BM. We evaluated the outcomes and potential prognostic factors of patients with BM treated with SRS. Material and Methods Retrospective review of patients treated with linac-based SRS for BM from BC in a single tertiary centre between August 2017-September 2021. Overall survival (OS), intracranial progression-free survival (IPFS), and prognostic factors were evaluated using Kaplan-Meier analysis, log-rank test, and Cox proportional-hazards model. Results 76 patients were included in the analysis. Out of these, 56 had first-line local treatment with SRS, either as primary (n=34) or adjuvant to surgery (n=22). Median age was 58 years old (range 37-86), and 88% had PS 0/1. One-year survival rate was 56%. Median OS and IPFS from SRS was 16 months (95% CI 8-24) and 7 months (95% CI 2-12), respectively. However, there were significant differences in OS (p<0.001) and IPFS (p=0.001) based on molecular subtypes. Patients with triple-negative breast cancer (TNBC) (n=14) had median OS of 7 months (95% CI 2-12), ER+/HER2- (n=22) median OS of 22 months, ER-/HER2+ (n=8) median OS of 4 months (95% CI 0-9), and ER+/HER2+ (n=11) median OS of 36 months. Similar trend was seen with IPFS. Patients with progressive extracranial disease compared to stable disease had shorter median OS (4 months vs 23 months, HR 2.4, p=0.01) and median IPFS (4 months vs 13 months, HR 2, p=0.03). Age ≥65 years was associated with shorter median OS (4 vs 23 months, HR 2.3, p=0.02). Patients with ≥4 brain metastases had shorter IPFS (4 months vs 11 months, HR 2.4, p=0.012), but no significant difference in OS. Volume of metastases did not affect outcome in this series. 30% of patients progressed intracranially after first-line SRS. 94 % had out-of-field recurrences, and 6% in-field recurrences. 59% had further SRS, 12 % WBRT, 6% surgery, and 23% had no further local treatment. 26 patients had second-line local treatment with SRS after first-line SRS (n=9), WBRT (n=9), or surgery +/- WBRT (n=8). There were no significant differences in outcome based on the modality of first-line local treatment. Conclusion SRS is an effective treatment for BM from BC. There were significant differences in survival based on age, molecular subtypes, and extracranial disease status.
INTRODUCTION Brain metastases (BM) are common in melanoma and historically associated with poor prognosis. Targeted systemic treatment have improved prognosis, and stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic option. We evaluated the outcomes and potential prognostic factors of patients treated with SRS. METHODS Retrospective study of patients treated with linac-based SRS for BM from melanoma in a UK tertiary centre between August 2017-September 2021. Overall survival (OS), intracranial progression-free survival (IPFS), and prognostic factors were evaluated using Kaplan–Meier analysis, log-rank test, and Cox proportional-hazards model. RESULTS Median follow up was 32 months. 69 patients were included. Median age was 59 years old (range 30-93), and 63% were male. 99% had performance status of 0/1. 45% had BRAF mutation, and 68% had stable extracranial disease at SRS. 62 patients had first-line treatment with SRS. 133 BM were treated, with mean volume of 0.39 cm3(range 0.02-18.82). Median prescription dose was 23 Gy (range 14-24Gy), prescribed to 100% isodose. Median OS and IPFS from SRS was 18 months (95% CI 5-31), and 12 months (95% CI 6-18), respectively. 6 months and 1 year local control (LC) rate were 79% and 64 %, respectively. 91% had out-of-field recurrences. Patients with BRAF mutation had shorter IPFS compared to BRAF WT (7 months vs 18 months, HR 2, p=0.04). 36% were on BRAF inhibitors, and IPFS were longer for patients on immunotherapy within 3 months of SRS (15 months vs 4 months, HR 2.6, p=0.03). There was non-significant trend towards shorter OS and IPFS for patients who were male, ≥ 65 years old, BRAF mutant, progressive extracranial disease, > 4 BM, and total volume of ≥ 5cm3. CONCLUSION SRS demonstrates good OS and LC for treatment of BM from melanoma. Prospective studies should establish the synergistic effects between targeted treatment and SRS.
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