Occult brain metastases in HER2-positive breast cancer patients: Frequency and response to radiotherapy

Niwińska, Anna; Tacikowska, M.; Pieńkowski, Tadeusz

doi:10.1080/02841860701316099

Cited by 19 publications

(22 citation statements)

References 7 publications

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“…Our study differs from the previous studies investigating asymptomatic BMs in HER2-positive breast cancer patients [13,14] in that we limited the time between diagnosis and brain imaging to 12 months. In the previous studies of Niwińska et al [13,14], the time between diagnosis and brain imaging was not limited (0-76 months and 0-84 months, respectively).…”

Section: Discussioncontrasting

confidence: 48%

“…In the previous studies of Niwińska et al [13,14], the time between diagnosis and brain imaging was not limited (0-76 months and 0-84 months, respectively). While the median time from diagnosis to brain imaging was 4.7 months in our study, it was 15 months in the study of Niwińska et al [13]. Hence, our study may provide useful information on the benefit of cranial imaging for staging in HER2-positive breast cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…In our series, the rate of asymptomatic BMs was 11.5% (n = 11/96) in all HER2-positive breast cancer patients (groups 1 and 2), and 22% (n = 9/41) in the HER2-positive metastatic breast cancer patients (group 2). Niwińska et al [13,14] reported 36% and 34% incidence of occult BMs in HER2-positive metastatic breast cancer patients. In the present study, the frequency of asymptomatic BMs was lower than those reported in the previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Our knowledge about the frequency of asymptomatic BMs in HER2-positive breast cancer patients was very limited before the studies of Niwińska et al [13,14]. Furthermore, no autopsy studies on this issue were performed after HER2 status assessment was introduced into routine clinical practice, so the previous autopsy studies did not provide information about the frequency of BMs in HER2-positive breast cancer patients [15,16,17,18,19,20,21,22,23,24,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 20-25% of all breast cancer patients present with HER2-positive breast cancer [8,9,10], which is a particularly aggressive subtype of breast cancer associated with poor prognosis [9]. Although routine cranial imaging is not recommended for asymptomatic breast cancer patients, autopsy studies [11] and other studies investigating occult BMs [12,13,14] suggest that cranial imaging is important in metastatic breast cancer patients. A recent study demonstrated that 90% of occult BMs were identified within 12 months after recurrence of the disease [14].…”

Section: Introductionmentioning

confidence: 99%

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Cranial Magnetic Resonance Imaging in the Staging of HER2-positive Breast Cancer Patients

Kaplan

İnal²,

Küçüköner³

et al. 2013

Oncol Res Treat

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Aim: The aim of the current study was to evaluate whether early detection of brain metastases (BMs) could improve survival outcomes in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients. Material and Methods: HER2-positive breast cancer patients without BMs who had no neurological symptoms within 12 months from diagnosis or relapse time of the disease were included in the study. The patients were distributed into 2 groups: Group 1 comprised patients without metastases; group 2 comprised patients with metastases. The symptomatic historic control group with BMs was defined retrospectively for survival comparisons. Results: 55 (57.3%) and 41 (42.7%) patients were in groups 1 and 2, respectively. 11 of the 96 patients (11.5%) had occult BMs, and 9 of them were in group 2 whereas only 2 patients were in group 1 (22% vs. 3.6%, respectively; p = 0.008). While the median survival times from the first metastasis (28.7 vs. 22.5 months, respectively; p = 0.561) and BM (6.8 vs. 6.1 months, respectively; p = 0.511) were similar, cerebral death was numerically different (16.7% vs. 46.3%; p = 0.221) between asymptomatic (n = 9) and symptomatic patients (n = 53). Conclusions: BMs were detected very rarely in asymptomatic, non-metastatic HER2-positive breast cancer patients compared with asymptomatic, metastatic patients. Furthermore, although early detection of BMs decreases the cerebral death rate, it does not prolong the survival rate in metastatic patients.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cranial Magnetic Resonance Imaging in the Staging of HER2-positive Breast Cancer Patients

Kaplan

İnal²,

Küçüköner³

et al. 2013

Oncol Res Treat

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Comparison of nine prognostic scores in patients with brain metastases of breast cancer receiving radiotherapy of the brain

Laakmann

Goy

Kersten

et al. 2015

J Cancer Res Clin Oncol

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Brain metastasis in breast cancer: a comprehensive literature review

et al. 2016

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This comprehensive review provides information on epidemiology, size, grade, cerebral localization, clinical symptoms, treatments, and factors associated with longer survival in 14,599 patients with brain metastasis from breast cancer; the molecular features of breast cancers most likely to develop brain metastases and the potential use of these predictive molecular alterations for patient management and future therapeutic targets are also addressed. The review covers the data from 106 articles representing this subject in the era of modern neuroimaging (past 35 years). The incidence of brain metastasis from breast cancer (24 % in this review) is increasing due to advances in both imaging technologies leading to earlier detection of the brain metastases and introduction of novel therapies resulting in longer survival from the primary breast cancer. The mean age at the time of breast cancer and brain metastasis diagnoses was 50.3 and 48.8 years respectively. Axillary node metastasis was noted in 32.8 % of the patients who developed brain metastasis. The median time intervals between the diagnosis of breast cancer to identification of brain metastasis and from identification of brain metastasis to death were 34 and 15 months, respectively. The most common symptoms experienced in patients with brain metastasis consisted of headache (35 %), vomiting (26 %), nausea (23 %), hemiparesis (22 %), visual changes (13 %) and seizures (12 %). A majority of the patients had multiple metastases (54.2 %). Cerebellum and frontal lobes were the most common sites of metastasis (33 and 16 %, respectively). Of the primary tumors for which biomarkers were recorded, 37 % were estrogen receptor (ER)+, 41 % ER-, 36 % progesterone receptor (PR)+, 34 % PR-, 35 % human epithelial growth factor receptor 2 (HER2)+, 41 % HER2-, 27 % triple negative and 18 % triple positive (TP). Treatment in most patients consisted of a multimodality approach often with two or more of the following: whole brain radiation therapy (52 %), chemotherapy (51 %), stereotactic radiosurgery (20 %), surgical resection (14 %), trastuzumab (39 %) for HER2 positive tumors, and hormonal therapy (34 %) for ER and/or PR positive tumors. Factors that had an impact on prognosis included grade and size of the tumor, multiple metastases, presence of extra-cranial metastasis, triple negative or HER2+ biomarker status, and high Karnovsky score. Novel therapies such as application of agents to reduce tumor angiogenesis or alter permeability of the blood brain barrier are being explored with preliminary results suggesting a potential to improve survival after brain metastasis. Other potential therapies based on genetic alterations in the tumor and the microenvironment in the brain are being investigated; these are briefly discussed.

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Occult brain metastases in HER2-positive breast cancer patients: Frequency and response to radiotherapy

Cited by 19 publications

References 7 publications

Cranial Magnetic Resonance Imaging in the Staging of HER2-positive Breast Cancer Patients

Cranial Magnetic Resonance Imaging in the Staging of HER2-positive Breast Cancer Patients

Comparison of nine prognostic scores in patients with brain metastases of breast cancer receiving radiotherapy of the brain

Brain metastasis in breast cancer: a comprehensive literature review

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