Shih-Fan Lai1,2, Yu-Hsuan Chen2, Tony Hsiang-Kuang Liang1,2, Che-Yu Hsu2, Huang-Chun Lien3, Yen-Sen Lu2,4, Chiun-Sheng Huang5, Sung-Hsin Kuo6,7,8,9. 1. Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan. 2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. 3. Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan. 4. National Taiwan University Cancer Center, College of Medicine, National Taiwan University, Taipei, Taiwan. 5. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. shkuo101@ntu.edu.tw. 7. National Taiwan University Cancer Center, College of Medicine, National Taiwan University, Taipei, Taiwan. shkuo101@ntu.edu.tw. 8. Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan. shkuo101@ntu.edu.tw. 9. Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan. shkuo101@ntu.edu.tw.
Abstract
INTRODUCTION: Whole brain (WB) re-irradiation for breast cancer patients with progressive brain metastasis after first-course WB radiotherapy (WBRT) is controversial. In this study, we sought to investigate the association between the molecular sub-classifications and breast-specific Graded Prognostic Assessment (GPA, which includes the Karnofsky performance status, molecular subtypes, and age as its indices) and the outcomes of breast cancer patients who received WB re-irradiation. METHODS: Twenty-three breast cancer patients who received WB re-irradiation for relapsed and progressive intracranial lesions after first-course WBRT between 2004 and 2016 were retrospectively reviewed. Patients were divided according to the 4 molecular subtypes of luminal A/B (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-), luminal HER2 (HR+/HER2+), HER2 (HR-/HER2+), and triple negative (HR-/HER2-). The clinical and radiological responses and survival rates after WB re-irradiation were analyzed. RESULTS: At 1 month after WB re-irradiation, 13 of 23 patients (56.5%) exhibited disappearance or alleviation of neurological symptoms. The median survival time after WB re-irradiation was 2.93 months (95% confidence interval [CI], 1.79-4.08). After WB re-irradiation, patients with HER2-negative tumors had poorer median survival times than those with HER2-positive tumors (2.23 vs. 3.0 months, respectively; p = 0.022). Furthermore, patients with high breast GPA scores (2.5-4.0, n = 11) had longer median survivals than those with low-scores (0-2.0, n = 12) after WB re-irradiation (4.37 vs. 1.57 months, respectively; p < 0.005). CONCLUSIONS: WB re-irradiation may be a feasible treatment option for certain breast cancer patients who develop brain metastatic lesions after first-course WBRT when these lesions are ineligible for radiosurgery or surgery.
INTRODUCTION: Whole brain (WB) re-irradiation for breast cancerpatients with progressive brain metastasis after first-course WB radiotherapy (WBRT) is controversial. In this study, we sought to investigate the association between the molecular sub-classifications and breast-specific Graded Prognostic Assessment (GPA, which includes the Karnofsky performance status, molecular subtypes, and age as its indices) and the outcomes of breast cancerpatients who received WB re-irradiation. METHODS: Twenty-three breast cancerpatients who received WB re-irradiation for relapsed and progressive intracranial lesions after first-course WBRT between 2004 and 2016 were retrospectively reviewed. Patients were divided according to the 4 molecular subtypes of luminal A/B (hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-), luminal HER2 (HR+/HER2+), HER2 (HR-/HER2+), and triple negative (HR-/HER2-). The clinical and radiological responses and survival rates after WB re-irradiation were analyzed. RESULTS: At 1 month after WB re-irradiation, 13 of 23 patients (56.5%) exhibited disappearance or alleviation of neurological symptoms. The median survival time after WB re-irradiation was 2.93 months (95% confidence interval [CI], 1.79-4.08). After WB re-irradiation, patients with HER2-negative tumors had poorer median survival times than those with HER2-positive tumors (2.23 vs. 3.0 months, respectively; p = 0.022). Furthermore, patients with high breast GPA scores (2.5-4.0, n = 11) had longer median survivals than those with low-scores (0-2.0, n = 12) after WB re-irradiation (4.37 vs. 1.57 months, respectively; p < 0.005). CONCLUSIONS: WB re-irradiation may be a feasible treatment option for certain breast cancerpatients who develop brain metastatic lesions after first-course WBRT when these lesions are ineligible for radiosurgery or surgery.
Entities:
Keywords:
Brain metastasis; Breast cancer; Re-irradiation; Whole-brain radiotherapy (WBRT)
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