Radiological Patterns of Brain Metastases in Breast Cancer Patients: A Subproject of the German Brain Metastases in Breast Cancer (BMBC) Registry

Abstract

Evidence about distribution patterns of brain metastases with regard to breast cancer subtypes and its influence on the prognosis of patients is insufficient. Clinical data, cranial computed tomography (CT) and magnetic resonance imaging (MRI) scans of 300 breast cancer patients with brain metastases (BMs) were collected retrospectively in four centers participating in the Brain Metastases in Breast Cancer Registry (BMBC) in Germany. Patients with positive estrogen (ER), progesterone (PR), or human epidermal growth factor receptor 2 (HER2) statuses, had a significantly lower number of BMs at diagnosis. Concerning the treatment mode, HER2-positive patients treated with trastuzumab before the diagnosis of BMs showed a lower number of intracranial metastases (p < 0.001). Patients with a HER2-positive tumor-subtype developed cerebellar metastases more often compared with HER2-negative patients (59.8% vs. 44.5%, p = 0.021), whereas patients with triple-negative primary tumors had leptomeningeal disease more often (31.4% vs. 18.3%, p = 0.038). The localization of Brain metastases (BMs) was associated with prognosis: patients with leptomeningeal disease had shorter survival compared with patients without signs of leptomeningeal disease (median survival 3 vs. 5 months, p = 0.025). A shorter survival could also be observed in the patients with metastases in the occipital lobe (median survival 3 vs. 5 months, p = 0.012). Our findings suggest a different tumor cell homing to different brain regions depending on subtype and treatment.

Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry

“…In a small cohort, HR-negative/HER2-positive breast cancer patients with BMs were more likely to present with occipital metastases [11]. Laakmann et al have published results on brain imaging of 400 breast cancer patients with BMs, of whom 102 had HER2-positive primary tumours, and observed also a correlation between HER2 positivity and metastases in the posterior fossa [12]. Here, we could confirm this finding in 314 patients with HER2-positive breast cancer in the BMBC registry.…”

<p>Breast Cancer Brain Metastasis: The Potential Role of MRI Beyond Current Clinical Applications</p>

“…The location of the metastasis in the brain has been shown to be associated with prognosis. Through MRI, a poor prognosis for patients with leptomeningeal disease was shown in several studies, 8,10 in comparison to nonleptomeningeal. 10 In one of these studies with a relatively high number (300) of BCBM patients a shorter survival was also observed in patients with metastases in the occipital lobe compared to other brain regions.…”

Characteristics and Clinical Outcome of Breast Cancer Patients with Asymptomatic Brain Metastases

“…Several risk factors for the development of seizures in patients with BM are described in the literature: For example, patients with a single BM, detection of tumoral hemorrhage, or supratentorial BM are at a higher risk [ 24 ]. Our previous analysis of the BMBC Registry showed that patients with positive estrogen or progesterone status have a lower number of BMs at diagnosis [ 25 ]. Thus, possibly a lower number of BMs in luminal-like patients could explain the higher probability of seizures.…”