Gamma knife surgery for the treatment of intracranial metastases from breast cancer

Abstract

The SIR and the KPS score are prognostic factors in patients whose intracranial breast cancer metastases are treated with GKS. The SIR, which includes the KPS score, patient age, systemic disease status, largest lesion volume, and number of lesions, can be used to identify those patients with breast cancer metastasis who would benefit from GKS better than KPS score alone. The contribution of whole-brain radiation therapy to GKS with regard to local tumor control or survival could not be identified.

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

“…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).…”

“…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).…”

“…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).…”

Stereotactic Radiosurgery in Treatment of Cerebral Metastases: Histological Differences in Predictors of Survival

“…A review of the histology specific literature reveals a wide variation within different histological subtypes, making generalizing any staging criteria difficult [6,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. To our knowledge, there are five studies (including the current study) reporting outcomes of brain metastasis from breast primaries with a study size of at least 100 patients [6,8,21,25].…”

Long Survival in a Patient with Brain Metastases from Breast Cancer

“…Median survival after the diagnosis of symptomatic central nervous system (CNS) involvement is roughly 4 months, and 2-year survival is less than 2% (2,3). When looking at radiosurgery series, a longer survival has been observed in selected groups of patients, with median survival ranging from 13 to 19 months (4,5). In a recent report (6), the median survival after diagnosis of symptomatic cerebral metastases in 72 patients with metastatic breast cancer treated in our Insitution was nine months.…”