Brain Metastases From Breast Carcinoma: Validation of the Radiation Therapy Oncology Group Recursive Partitioning Analysis Classification and Proposition of a New Prognostic Score

Scodan, Romuald Le; Massard, Christophe; Mouret-Fourme, Emmanuelle; Guinebretierre, Jean Marc; Cohen-Solal, C.; Lalande, B. De; Moisson, P; Breton-Callu, C.; Gardner, M.; Goupil, A; Renody, N.; Floiras, J.-L.; Labib, A.

doi:10.1016/j.ijrobp.2007.04.024

Cited by 61 publications

(51 citation statements)

References 24 publications

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“…Certain studies demonstrated that the presence of pretreatment lymphopenia is associated with poor cancer survival or tumor response and it has not only prognostic, but also predictive potential (12-14). In a study conducted by the Radiation Therapy Oncology Group, lymphopenia and hormone receptor negativity were found to be independent prognostic factors indicating poor survival in breast cancer patients with brain metastases (15). A more recent study conducted by the same group concluded that lymphocyte count and LDH levels may predict overall survival (16).…”

Section: Discussionmentioning

confidence: 99%

Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab

Gündüz

Göksu

Arslan

et al. 2015

Molecular and Clinical Oncology

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Abstract. Breast cancer is the most frequently diagnosed cancer in women worldwide and the second cause of cancer-related mortality. A total of 20-30% of patients with early-stage breast cancer develop recurrence within the first 5 years following diagnosis. Trastuzumab significantly improves overall survival and disease-free survival (DFS) in women with human epidermal growth factor receptor 2 (HER2)-positive early and locally advanced breast cancer. This study aimed to determine the factors that affect DFS following adjuvant transtuzumab therapy. A total of 62 patients treated with trastuzumab for early and locally advanced breast cancer were included in our study. Data, including pathology, treatment and treatment outcome, rate of recurrence and laboratory tests, were retrospectively collected. There was no significant association between DFS and age, menopausal status, disease stage and hormone receptor status. The median follow-up was 48.4 months. The median DFS of patients treated with adjuvant trastuzumab was 64.1 months. In addition, the median DFS was 44.3 vs. 66.8 months in patients with platelet-lymphocyte ratio (PLR) ≤200 vs. >200, respectively (log-rank test; P=0.001), and 70 vs. 45 months in patients with eosinophil count ≤70 vs. >70x10 3 ̸mm 3 (log-rank test; P=0.001). Our data revealed the prognostic relevance of a decrease in the peripheral blood eosinophil count and PLR value following trastuzumab therapy in breast cancer. PLR and eosinophil count measurements are cost-effective, readily available worldwide, non-invasive and safe. Combined with other markers, such as patient age, tumor stage and tumor histology, may be effectively used for patients with breast cancer.

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Section: Discussionmentioning

confidence: 99%

Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab

Gündüz

Göksu

Arslan

et al. 2015

Molecular and Clinical Oncology

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“…Although there have been conflicting findings, numerous variables have been shown to have some prognostic value including the following: Basal subtype (20,21,51); whole brain radiation dose of greater than or equal to 30 Gy (20,22); KPS (19,(22)(23)(24)(25)(26)(27)(28)(29)(30); presence/degree of extracranial metastases (21-23,27,30,31); primary tumor control (24,32); size of primary tumor (22); interval from first cancer diagnosis to brain metastases (23); number of brain metastases (22,23,32,33); solitary metastasis (22,34); age (19,21,24,30,34); ER status (21,24,26); HER2 expression (22,24,29,30,32,35); systemic chemotherapy (28); lymphopenia (29,36); and surgical resection (28,31).…”

Section: Discussionmentioning

confidence: 99%

“…However, they acknowledge the shortcomings of their model and state, "Without doubt, the definitive prognostic score can only be created from a very large database." Other groups have also confirmed the prognostic value of the RPA system (20,29,31,37) and SIR in terms of survival (19,26). Le Scodan created a prognostic system based on the variables found to be statistically significant in their analysis however this was a small study (n=117) from a single institution, treated with WBRT alone (29).…”

Section: Other Indicesmentioning

confidence: 94%

“…Multiple studies have demonstrated tumor subtype affects prognoses (16)(17)(18), however, neither the RTOG-RPA classification system nor the current Breast-Specific GPA system include tumor subtype in their models. Many other authors have described other prognostic factors, albeit with conflicting findings (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Gaspar et al published a seminal work on a prognostic index for patients with brain metastases, the Radiation Therapy Oncology Group's Recursive Partitioning Analysis (RTOG-RPA) in 1997 (38).…”

Section: Introductionmentioning

confidence: 99%

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The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases.

Sperduto¹,

Kased²,

Roberge³

et al. 2011

JCO

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“…These classes were based on the KPS score, primary tumor status, the presence of extracranial system metastases and age. Several studies have confirmed that the RPA classes are valid and reliable for historical comparisons (32,49).…”

Section: Natural Course and Prognostic Factorsmentioning

confidence: 87%

Brain Metastases in Breast Cancer

Niikura

Tokuda

Iwata

2014

Japanese Journal of Clinical Oncology

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Brain metastases are less common than bone or visceral metastases in patients with breast cancer. The overall prognosis of breast cancer patients with brain metastases remains poor, and these metastases are less responsive to systemic therapies. Brain metastasis is associated with a reduced quality of life due to progressive neurologic impairments. Recently, a trend of increased incidence of brain metastases in breast cancer has been noted. Reasons for this increased incidence include the more frequent use of sensitive detection methods such as contrast-enhanced magnetic resonance imaging and increased awareness of brain metastasis among patients and clinicians. Adjuvant and systemic therapy with drugs that have a low blood -brain barrier penetrance can lead to an increased risk of brain metastases in breast cancer patients. Molecular subtype is a predictive factor for overall survival after developing brain metastases. Patients who do not have a poor prognosis based on previously identified prognostic factors should be treated with radiation therapy to control symptoms. Whole-brain radiation therapy, stereotactic irradiation and surgery are tools for the local treatment of brain metastases. Novel molecular target therapy, including HER2-targeted therapy, has demonstrated an antitumor effect on brain metastases. In this review, we provide a practical algorithm for the treatment of breast cancer brain metastases. This review provides an overview of the incidence, risk factors, diagnosis, prognostic factors and current and potential future management strategies of breast cancer brain metastases.

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Brain Metastases From Breast Carcinoma: Validation of the Radiation Therapy Oncology Group Recursive Partitioning Analysis Classification and Proposition of a New Prognostic Score

Cited by 61 publications

References 24 publications

Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab

Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab

The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases.

Brain Metastases in Breast Cancer

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