Treatment and outcomes in patients with central nervous system metastases from breast cancer in the real-life ESME MBC cohort

Pasquier, David; Darlix, Amélie; Louvel, G.; Fraisse, Julien; Jacot, William; Brain, Étienne; Petit, A.; Mouret-Reynier, Marie Ange; Gonçalvès, Anthony; Deluche, Élise; Fresnel, Jean Sébastien; Augereau, Paule; Ferrero, Jean Marc; Geffrelot, Julien; Fumet, Jean-David; Lecouillard, I.; Cottu, Paul; Petit, Thierry; Uwer, Lionel; Jouannaud, Christelle; Leheurteur, Marianne; Dièras, Véronique; Robain, Mathieu; Mouttet-Audouard, Raphaëlle; Bachelot, Thomas; Courtinard, Coralie

doi:10.1016/j.ejca.2019.11.001

Cited by 34 publications

(37 citation statements)

References 21 publications

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“…TNBC is a subgroup with a high risk of brain metastasis, in our whole population 40%, despite the commonly short post-recurrence survival. This is concordant with recently published data from a French multicenter database with more than 4000 BC patients with brain metastasis [26]. More than 50% of the younger patients were diagnosed with brain metastasis.…”

Section: Discussionsupporting

confidence: 92%

A comparison between young and old patients with triple-negative breast cancer: biology, survival and metastatic patterns

Tzikas

Nemes

Linderholm

2020

Breast Cancer Res Treat

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Purpose To determine the biology, recurrence rate, metastatic patterns and survival times in primary triple-negative breast cancer (TNBC) with focus on the comparison between younger and elderly patients. Methods Patients with primary TNBC stage I-IV diagnosed from 2007 to 2015 were identified and information on tumor biology, stage, treatment, recurrences and death recorded. Results A total of 524 patients, median age 60 years (range 24-94) with a median follow-up of 55 months (range 0-129) were identified. Stage was similar in younger (< 40 years) (n = 58) and older (> 74 years) (n = 96) patients (p = 0.37). A statistically significant difference was found concerning histopathologic grade (p = 0.006) and Ki67 (median 80% versus 70%; p = 0.002) but not for LVI (p = 0.9) with more aggressive tumors among younger patients. Adjuvant/neoadjuvant chemotherapy was more frequently given to younger compared with older patients (96% versus 12%; p = 0.0005). Only brain (p = 0.016) and liver (p = 0.047) metastases were more often registered among younger patients while other locations were similar. Shorter survival times, recurrence-free survival (RFS), distant disease-free survival (DDFS) and breast cancer-specific survival (BCSS) were found in the older group, although not after adjusting for adjuvant/neoadjuvant chemotherapy. Most deaths (68%) in the older group were caused by TNBC. When comparing patients > 75 years (n = 92) with ≤ 75 years (n = 432), a worse outcome among older was also observed: RFS (p = 0.00012), DDFS (p = 0.00041), BCSS (p < 0.0001) and survival following distant metastasis (p = 0.0064) Conclusions Primary TNBC in younger patients is more often of poor differentiation grade and highly proliferative compared with older patients. The majority of older patients still have grade III tumors with a Ki67 > 60% and outcome is poor. Few older patients in our study were treated with chemotherapy both in adjuvant and palliative setting, underlining the need for more prospective trials and treatment options suitable for this patient population.

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Section: Discussionsupporting

confidence: 92%

A comparison between young and old patients with triple-negative breast cancer: biology, survival and metastatic patterns

Tzikas

Nemes

Linderholm

2020

Breast Cancer Res Treat

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“…Therefore, in this study, the impact of local treatment on BCBM prognosis was mainly analyzed. WBRT was widely used in the treatment of brain metastases, but its ability to improve the prognosis was still controversial (26,27). In this study, we observed whether or not receiving whole brain radiotherapy was an independent factor affecting SABM.…”

Section: Discussionmentioning

confidence: 78%

Analysis of Prognostic Factors Affecting the Brain Metastases Free Survival and Survival After Brain Metastases in Breast Cancer

et al. 2020

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This study aimed to analyze the factors affecting brain metastases free survival (BMFS) and the survival after brain metastases (SABM). The data of 215 patients with breast cancer brain metastases (BCBM) in Sun Yat-sen University Cancer Center from January 2000 to August 2017 were retrospectively analyzed. The clinicopathological features of BCBM were analyzed, and their effects on BMFS and SABM were analyzed by univariate and multivariate COX regression. Finally, it was analyzed whether the receptor status of the brain metastases and the primary lesions were consistent. The median age of the entire cohort was 46 years old. The median BMFS, SABM and overall survival were 31, 9 and 44.2 months, respectively. Clinical stage, molecular subtypes and bone metastasis were independent prognostic factors affecting BMFS. TNM stage IV (HR, 4.99 [95% CI, 2.13-11.7]) and triple negative subtype (HR, 2.06 [95% CI, 1.35-3.14]) was significantly associated with shorter BMFS, but the presence of bone metastases (HR, 0.63 [95% CI, 0.45-0.88]) was a favorable factor for BMFS. Molecular subtypes, resection of BCBM and whole brain radiotherapy (WBRT) were independent factors for SABM. The triple negative subtype (HR, 2.02[95% CI, 1.12-3.64]) was significantly associated with shorter SABM. However, resection of BCBM (HR, 0.31 [95% CI, 0.15-0.65]) and WBRT (HR, 0.57 [95% CI, 0.35-0.93]) were independent factors in improving SABM. The conversion rate of ER was 11.1%, PR was 29.6%, and HER2 was 3.7% between paired breast cancer and brain metastases. BMFS and SABM have different influencing factors. Resection of BCBM and WBRT can significantly improve SABM. The frequency of HER2 status changes between the paired BCBM and the primary lesions is low.

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“…6,9,11 Reported OS in breast cancer patients after treatment with either WBRT alone or SRS was 4-8 and 13-16 months, respectively. 9,10,24 Patients with poorly controlled extracranial disease and poor performance status are more often referred to WBRT 23 implying a generally shorter OS compared to patients referred to SRS. Further, studies on the effect of WBRT and SRS in combination versus SRS alone have not shown significant differences in OS.…”

Section: Introductionmentioning

confidence: 99%

“…15,25 The use of SRS is increasing overall, including in breast cancer patients with brain metastases. 24,26 As length of survival after brain metastasis diagnosis is increasing, 8 prevention of late side effects becomes more important. Therefore, it is relevant to gain knowledge about clinical practice by studying changes over time in the use of RT and survival after RT for brain metastases in breast cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

Gullhaug

Hjermstad

Yri

et al. 2021

Journal of Medical Imaging and Radiation Sciences

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Aim: To analyse the use of radiotherapy (RT) and factors affecting overall survival (OS) after RT in breast cancer patients with brain metastases.Methods: Breast cancer patients treated from 2008 to 2018 with whole brain RT (WBRT) or stereotactic radiosurgery (SRS) at a large regional cancer referral center were identified from the hospital's RT register. Clinical variables were extracted from medical records. OS was calculated from date of first RT until death or last follow up. Potential factors affecting OS were analyzed.Results: 255 females with WBRT (n ¼ 206) or SRS (n ¼ 49) as first RT were included. An increased use of initial SRS was observed in the second half of the study period. The most common WBRT fractionation regimen was 3 Gy Â 10. SRS was most often single fractions; 18 or 25 Gy between 2009 and 2016, while fractionated SRS was mostly used in 2017 and 2018. Median OS in the WBRT group was 6 months (CI 1-73) relative to 23 (CI 0-78) in the SRS group. Age, performance status, initial RT technique, extracranial disease, brain metastasis surgery, number of brain metastases and DS-GPA score had significant impact on OS. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis. Conclusion:WBRT was the most frequent primary RT. An increased use of initial SRS was observed in the second half of the study period. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis.R ESUM E But : Analyser l'utilisation de la radioth erapie (RT) et les facteurs affectant la survie globale (SG) apr es la RT chez les patientes atteintes d'un cancer du sein avec m etastases au cerveau.Contributors: All authors contributed to the conception or design of the work, the acquisition, analysis, or interpretation of the data. All authors were involved in drafting and commenting on the paper and have approved the final version.

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Treatment and outcomes in patients with central nervous system metastases from breast cancer in the real-life ESME MBC cohort

Cited by 34 publications

References 21 publications

A comparison between young and old patients with triple-negative breast cancer: biology, survival and metastatic patterns

A comparison between young and old patients with triple-negative breast cancer: biology, survival and metastatic patterns

Analysis of Prognostic Factors Affecting the Brain Metastases Free Survival and Survival After Brain Metastases in Breast Cancer

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

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