Focalized treatment strategy for patients with 1 to 5 breast cancer brain metastasis: a retrospective study of 70 patients treated with surgery or stereotactic radiosurgery

Abstract

Background: Systemic treatment for metastatic breast cancer (MBC) has improved, allowing better control of extracranial disease, and longer survival. As a consequence, incidence of brain metastasis (BM) increases. Focalized treatment with surgical excision or stereotactic radiosurgery (SRS) should be considered for patients with a low number of BM. Methods: We identified all MBC patients undergoing focalized treatment by surgery or SRS, for 1 to 5 BM in our institution, between January 2008 and January 2015, with the aim of describing their outcome. Results: 70 patients were identified: 39 treated with surgery for 1 to 2 BM, 29 treated with SRS for 1 to 5 BM, and 2 patients treated with both modalities for 2 to 3 BM. After a median follow-up of 49 months, 55% of patients (38 among 69) had brain recurrence. From focalized treatment of BM, recurrence-free survival (RFS) was 20 months for the whole cohort (n = 69, [11-26]). From BM diagnosis, median OS was 37 months (n = 70, 95%CI[20-52]) for the whole cohort, with significant differences according to tumor subtypes (p = 0.008, log-rank test, see table below). In multivariate analysis, HR positivity (HR a 0,39 [0,16-0,93], p = 0.033), and extracranial disease control (HR a 0,15 [0,06-0,39], p < 0.001), were associated with significant better outcome. At the time of analysis, 41 patients among 70 (56%) had died, including 23 from isolated neurologic cause. Nine patients died from leptomeningeal evolution. Eight patients developed severe neurologic symptoms, leading to death for 7 of them. Seven patients among these 8 had previous whole-brain radiation therapy (WBRT). Conclusions: Patients with a low number of BM from MBC who had aggressive treatment with surgery or SRS have a favorable outcome. WBRT use should be delayed as much as possible, to avoid neurocognitive sequelae. (Table Presented).