Stereotactic radiosurgery and local control of brain metastases from triple-negative breast cancer

Kowalchuk, Roman O.; Niranjan, Ajay; Hess, Judith; Antonios, Joseph; Zhang, Michael Y.; Braunstein, Steve; Ross, Ronald J.; Pikis, Stylianos; Deibert, Christopher P.; Lee, Cheng-chia; Yang, Huai‐Che; Langlois, Anne-Marie; Mathieu, David; Peker, Selçuk; Samancı, Yavuz; Rusthoven, Chad G.; Chiang, Veronica; Wei, Zhishuo; Lunsford, L. Dade; Trifiletti, Daniel M.; Sheehan, Jason P.

doi:10.3171/2022.10.jns221900

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…In our cohort, the median OS of BCBM was 25 months for all patients and 41 months for patients with HR+/HER2+ disease, more than twice that in older series. 22-28 We believe that this difference in OS compared with previous studies can be explained by our institution's high threshold for the number of tumors (≥25) that can be safely treated at once with SRS to control CNS progression. 29,30 In addition, recent studies proved that newer TT can cross the blood-brain barrier and affect BM, and thus, using TT with an SRS maintenance approach holds promise to patients with BCBM.…”

Section: Discussionmentioning

confidence: 79%

Long-term Survival From Breast Cancer Brain Metastases in the Era of Modern Systemic Therapies

et al. 2023

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BACKGROUND AND OBJECTIVES: Median survival for all patients with breast cancer with brain metastases (BCBMs) has increased in the era of targeted therapy (TT) and with improved local control of intracranial tumors using stereotactic radiosurgery (SRS) and surgical resection. However, detailed characterization of the patients with long-term survival in the past 5 years remains sparse. The aim of this article is to characterize patients with BCBM who achieved long-term survival and identify factors associated with the uniquely better outcomes and to find predictors of mortality for patients with BCBM. METHODS: We reviewed 190 patients with breast cancer with 931 brain tumors receiving SRS who were followed at our institution with prospective data collection between 2012 and 2022. We analyzed clinical, molecular, and imaging data to assess relationship to outcomes and tumor control. RESULTS: The median overall survival from initial SRS and from breast cancer diagnosis was 25 months (95% CI 19-31 months) and 130 months (95% CI 100-160 months), respectively. Sixteen patients (17%) achieved long-term survival (survival ≥5 years from SRS), 9 of whom are still alive. Predictors of long-term survival included HER2+ status (P = .041) and treatment with TT (P = .046). A limited number of patients (11%) died of central nervous system (CNS) causes. A predictor of CNS-related death was the development of leptomeningeal disease after SRS (P = .025), whereas predictors of non-CNS death included extracranial metastases at first SRS (P = .017), triple-negative breast cancer (P = .002), a Karnofsky Performance Status of <80 at first SRS (P = .002), and active systemic disease at last follow-up (P = .001). Only 13% of patients eventually needed whole brain radiotherapy. Among the long-term survivors, none died of CNS progression. CONCLUSION: Patients with BCBM can achieve long-term survival. The use of TT and HER2+ disease are associated with long-term survival. The primary cause of death was extracranial disease progression, and none of the patients living ≥5 years died of CNS-related disease.

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Section: Discussionmentioning

confidence: 79%

Long-term Survival From Breast Cancer Brain Metastases in the Era of Modern Systemic Therapies

et al. 2023

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“…Three patients underwent hypofractionated SRS (3 sessions) because of large tumor volumes (10.3 cc, 20.1 cc, and 27.7 cc) and received a median total cumulative margin dose of 27 Gy (range: 27-30). All other patients underwent single-session SRS and received a median margin dose of 18 Gy (range: [13][14][15][16][17][18][19][20]. The median single-session maximum dose was 32 Gy (range: 20-40 Gy).…”

Section: Srs Treatment Characteristicsmentioning

confidence: 99%

“…SRS has been established as an effective and noninvasive treatment modality for BMs from other systemic cancers. 12-16 Because of the rarity of CRC BMs, there are currently no established treatment protocols. 11,17 This study presents our single-institution experience in using SRS to manage CRC BMs and focuses on overall survival (OS), local tumor control (LTC), and prognostic risk factors.…”

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confidence: 99%

The Role of Stereotactic Radiosurgery in Patients With Brain Metastases From Colorectal Cancers

Taori,

Wei,

Deng

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: The role of stereotactic radiosurgery (SRS) in patients with brain metastases (BMs) from colorectal cancers (CRCs) has not been established. The authors present a single-institution experience of patients with CRC who underwent SRS with metastatic brain spread. METHODS: We retrospectively analyzed 111 patients with metastatic CRC (64 female, 57.7%), with 449 BMs treated with Gamma Knife SRS between 2000 and 2022. The median age during SRS was 63 years (range: 28-86), and the median Karnofsky Performance Scale was 80 (range: 60-100). The primary sites were colon (85 patients, 76.6%) and rectal (26 patients, 23.4%). Three patients underwent hypofractionated SRS (3 sessions) with a median margin dose of 27 Gy (range: 27-30). All other patients underwent single-session SRS with a median margin dose of 18 Gy (range: 13-20). RESULTS: The median patient survival after SRS was 7 months (range: 1-174). Ninety-eight (88.3%) patients expired at last follow-up and 15 patients (15.3%) died related to progressive intracranial disease. A Karnofsky Performance Scale of <80 at SRS presentation (P = .02, hazard ratio [HR]: 0.6, 95% CI: 0.4-0.9) and no previous surgical resection (P < .01, HR: 0.4, 95% CI: 0.3-0.7) were associated with inferior overall survival using multivariate analysis. Seventeen patients (15.3%) had documented local tumor progression after SRS, at a median time of 7 months (range: 3-34) between SRS and progression. Twenty-six patients (23.4%) developed new BMs at a median of 5 months (range: 2-26) between SRS and new tumor detection. Less than three BMs at SRS presentation (P = .02, HR: 2.6, 95% CI: 1.2-5.6) were associated with better distant tumor control on multivariate analysis. The incidence of adverse radiation effects was 5.4%. CONCLUSION: SRS effectively controls BMs from CRC with low risk of treatment-related toxicity. During follow-up, the development of additional metastases can be safely treated by repeat SRS.

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“…SRS alone has been established as a safe and effective local treatment of brain metastases. It is also used for adjuvant management after prior surgery or failed fractionated radiation therapy [7][8][9]. In this multi-center retrospective study, we evaluated the safety and e cacy of SRS for brain metastases from HER2positive primary breast cancer during an 18-year interval.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Radiosurgery for Brain Metastases from Human Epidermal Receptor 2 Positive Breast Cancer: An International, Multi-center Study

Pikis,

Mantziaris,

Protopapa

et al. 2024

Preprint

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Purpose To report patient outcomes and local tumor control rates in a cohort of patients with biopsy-proven HER-2 positive breast cancer treated with stereotactic radiosurgery (SRS) for brain metastases (BM). Methods This international, retrospective, multicenter study, included 195 female patients with 1706 SRS-treated BM. Radiologic and clinical outcomes after SRS were determined and prognostic factors identified. Results At SRS, median patient age was 55 years [interquartile range (IQR) 47.6–62.0], and 156 (80%) patients had KPS ≥ 80. The median tumor volume was 0.1 cm3 (IQR 0.1–0.5) and the median prescription dose was 16 Gy (IQR 16–18). Local tumor control (LTC) rate was 98%, 94%, 93%, 90%, and 88% at six-, 12-, 24-, 36- and 60-months post-SRS, respectively. On multivariate analysis, tumor volume (p = < 0.001) and concurrent pertuzumab (p = 0.02) improved LTC. Overall survival (OS) rates at six-, 12-, 24-, 36-, 48-, and 60-months were 90%, 69%, 46%, 27%, 22%, and 18%, respectively. Concurrent pertuzumab improved OS (p = 0.032). In this patient subgroup, GPA scores ≥ 2.5 (p = 0.038 and p = 0.003) and rare primary tumor histologies (p = 0.01) were associated with increased and decreased OS respectively. Asymptomatic adverse radiation events (ARE) occurred in 27 (14.0%) and symptomatic ARE in five (2.6%) patients. Invasive lobular carcinoma primary (p = 0.042) and concurrent pertuzumab (p < 0.001) conferred an increased risk for overall but not for symptomatic ARE. Conclusion SRS affords effective LTC for selected patients with BM from HER-2 positive breast cancer. Concurrent pertuzumab improved LTC and OS with however an increased risk for overall but not symptomatic ARE.

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Stereotactic radiosurgery and local control of brain metastases from triple-negative breast cancer

Cited by 8 publications

References 28 publications

Long-term Survival From Breast Cancer Brain Metastases in the Era of Modern Systemic Therapies

Long-term Survival From Breast Cancer Brain Metastases in the Era of Modern Systemic Therapies

The Role of Stereotactic Radiosurgery in Patients With Brain Metastases From Colorectal Cancers

Stereotactic Radiosurgery for Brain Metastases from Human Epidermal Receptor 2 Positive Breast Cancer: An International, Multi-center Study

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