Importance of Extracranial Disease Status and Tumor Subtype for Patients Undergoing Radiosurgery for Breast Cancer Brain Metastases
Purpose In this retrospective study, we report on outcomes and prognostic factors for patients treated with stereotactic radiosurgery (SRS) for breast cancer brain metastases. Methods and Materials We identified 132 consecutive patients with breast cancer who were treated with SRS for brain metastas...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2012-07, Vol.83 (4), p.e479-e486 |
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| creator | Dyer, Michael A., B.A Kelly, Paul J., M.B Chen, Yu-Hui, M.S., M.P.H Pinnell, Nancy E., B.A Claus, Elizabeth B., M.D., Ph.D Lee, Eudocia Q., M.D., M.P.H Weiss, Stephanie E., M.D Arvold, Nils D., M.D Lin, Nancy U., M.D Alexander, Brian M., M.D., M.P.H |
| description | Purpose In this retrospective study, we report on outcomes and prognostic factors for patients treated with stereotactic radiosurgery (SRS) for breast cancer brain metastases. Methods and Materials We identified 132 consecutive patients with breast cancer who were treated with SRS for brain metastases from January 2000 through June 2010. We retrospectively reviewed records of the 51 patients with adequate follow-up data who received SRS as part of the initial management of their brain metastases. Overall survival (OS) and time to central nervous system (CNS) progression from the date of SRS were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Results Triple negative subtype was associated with CNS progression on univariate analysis (hazard ratio [HR] = 5.0, p = 0.008). On multivariate analysis, triple negative subtype (HR = 8.6, p = 0.001), Luminal B subtype (HR = 4.3, p = 0.03), and omission of whole-brain radiation therapy (HR = 3.7, p = 0.02) were associated with CNS progression. With respect to OS, Karnofsky Performance Status (KPS) ≤ 80% (HR = 2.0, p = 0.04) and progressive extracranial disease (HR = 3.1, p = 0.002) were significant on univariate analysis; KPS ≤ 80% (HR = 4.1, p = 0.0004), progressive extracranial disease (HR = 6.4, p < 0.0001), and triple negative subtype (HR = 2.9, p = 0.04) were significant on multivariate analysis. Although median survival times were consistent with those predicted by the breast cancer-specific Graded Prognostic Assessment (Breast-GPA) score, the addition of extracranial disease status further separated patient outcomes. Conclusions Tumor subtype is associated with risk of CNS progression after SRS for breast cancer brain metastases. In addition to tumor subtype and KPS, which are incorporated into the Breast-GPA, progressive extracranial disease may be an important prognostic factor for OS. |
| doi_str_mv | 10.1016/j.ijrobp.2012.01.054 |
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Methods and Materials We identified 132 consecutive patients with breast cancer who were treated with SRS for brain metastases from January 2000 through June 2010. We retrospectively reviewed records of the 51 patients with adequate follow-up data who received SRS as part of the initial management of their brain metastases. Overall survival (OS) and time to central nervous system (CNS) progression from the date of SRS were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Results Triple negative subtype was associated with CNS progression on univariate analysis (hazard ratio [HR] = 5.0, p = 0.008). On multivariate analysis, triple negative subtype (HR = 8.6, p = 0.001), Luminal B subtype (HR = 4.3, p = 0.03), and omission of whole-brain radiation therapy (HR = 3.7, p = 0.02) were associated with CNS progression. With respect to OS, Karnofsky Performance Status (KPS) ≤ 80% (HR = 2.0, p = 0.04) and progressive extracranial disease (HR = 3.1, p = 0.002) were significant on univariate analysis; KPS ≤ 80% (HR = 4.1, p = 0.0004), progressive extracranial disease (HR = 6.4, p < 0.0001), and triple negative subtype (HR = 2.9, p = 0.04) were significant on multivariate analysis. Although median survival times were consistent with those predicted by the breast cancer-specific Graded Prognostic Assessment (Breast-GPA) score, the addition of extracranial disease status further separated patient outcomes. Conclusions Tumor subtype is associated with risk of CNS progression after SRS for breast cancer brain metastases. In addition to tumor subtype and KPS, which are incorporated into the Breast-GPA, progressive extracranial disease may be an important prognostic factor for OS.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2012.01.054</identifier><identifier>PMID: 22704705</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; BRAIN ; Brain metastases ; Brain Neoplasms - mortality ; Brain Neoplasms - pathology ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Breast cancer ; Breast Neoplasms - chemistry ; Breast Neoplasms - drug therapy ; Disease Progression ; Extracranial disease ; Female ; HAZARDS ; Hematology, Oncology and Palliative Medicine ; Humans ; Karnofsky Performance Status ; MAMMARY GLANDS ; METASTASES ; Middle Aged ; MULTIVARIATE ANALYSIS ; NEOPLASMS ; PATIENTS ; PHENOBARBITAL ; Prognosis ; Proportional Hazards Models ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery ; RADIOTHERAPY ; Retrospective Studies ; SURGERY ; Treatment Outcome ; Tumor Burden ; Tumor subtype</subject><ispartof>International journal of radiation oncology, biology, physics, 2012-07, Vol.83 (4), p.e479-e486</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-ea4c57b099520c9eab1fe8a8448c723bb58e79386b8c4b404cbfdc251768b5493</citedby><cites>FETCH-LOGICAL-c445t-ea4c57b099520c9eab1fe8a8448c723bb58e79386b8c4b404cbfdc251768b5493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2012.01.054$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22704705$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22058942$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Dyer, Michael A., B.A</creatorcontrib><creatorcontrib>Kelly, Paul J., M.B</creatorcontrib><creatorcontrib>Chen, Yu-Hui, M.S., M.P.H</creatorcontrib><creatorcontrib>Pinnell, Nancy E., B.A</creatorcontrib><creatorcontrib>Claus, Elizabeth B., M.D., Ph.D</creatorcontrib><creatorcontrib>Lee, Eudocia Q., M.D., M.P.H</creatorcontrib><creatorcontrib>Weiss, Stephanie E., M.D</creatorcontrib><creatorcontrib>Arvold, Nils D., M.D</creatorcontrib><creatorcontrib>Lin, Nancy U., M.D</creatorcontrib><creatorcontrib>Alexander, Brian M., M.D., M.P.H</creatorcontrib><title>Importance of Extracranial Disease Status and Tumor Subtype for Patients Undergoing Radiosurgery for Breast Cancer Brain Metastases</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose In this retrospective study, we report on outcomes and prognostic factors for patients treated with stereotactic radiosurgery (SRS) for breast cancer brain metastases. Methods and Materials We identified 132 consecutive patients with breast cancer who were treated with SRS for brain metastases from January 2000 through June 2010. We retrospectively reviewed records of the 51 patients with adequate follow-up data who received SRS as part of the initial management of their brain metastases. Overall survival (OS) and time to central nervous system (CNS) progression from the date of SRS were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Results Triple negative subtype was associated with CNS progression on univariate analysis (hazard ratio [HR] = 5.0, p = 0.008). On multivariate analysis, triple negative subtype (HR = 8.6, p = 0.001), Luminal B subtype (HR = 4.3, p = 0.03), and omission of whole-brain radiation therapy (HR = 3.7, p = 0.02) were associated with CNS progression. With respect to OS, Karnofsky Performance Status (KPS) ≤ 80% (HR = 2.0, p = 0.04) and progressive extracranial disease (HR = 3.1, p = 0.002) were significant on univariate analysis; KPS ≤ 80% (HR = 4.1, p = 0.0004), progressive extracranial disease (HR = 6.4, p < 0.0001), and triple negative subtype (HR = 2.9, p = 0.04) were significant on multivariate analysis. Although median survival times were consistent with those predicted by the breast cancer-specific Graded Prognostic Assessment (Breast-GPA) score, the addition of extracranial disease status further separated patient outcomes. Conclusions Tumor subtype is associated with risk of CNS progression after SRS for breast cancer brain metastases. In addition to tumor subtype and KPS, which are incorporated into the Breast-GPA, progressive extracranial disease may be an important prognostic factor for OS.</description><subject>Adult</subject><subject>Aged</subject><subject>BRAIN</subject><subject>Brain metastases</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - surgery</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - chemistry</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Disease Progression</subject><subject>Extracranial disease</subject><subject>Female</subject><subject>HAZARDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Karnofsky Performance Status</subject><subject>MAMMARY GLANDS</subject><subject>METASTASES</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>NEOPLASMS</subject><subject>PATIENTS</subject><subject>PHENOBARBITAL</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery</subject><subject>RADIOTHERAPY</subject><subject>Retrospective Studies</subject><subject>SURGERY</subject><subject>Treatment Outcome</subject><subject>Tumor Burden</subject><subject>Tumor subtype</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk2L1TAUhosoznX0H4gE3LhpTdKkHxtBr6MOjCjeGXAXkvT0mtomNUnFu_aPm9rRhRtX-eA573s478myxwQXBJPq-VCYwTs1FxQTWmBSYM7uZDvS1G1ecv75brbDZYXzMsFn2YMQBowxITW7n51RWmNWY77Lfl5Os_NRWg3I9ejiR_RSe2mNHNFrE0AGQIco4xKQtB26Xibn0WFR8TQD6tP9o4wGbAzoxnbgj87YI_okO-PC4o_gT7-hVz4JRbRfbdaXNBa9h5j-kn54mN3r5Rjg0e15nt28ubjev8uvPry93L-8yjVjPOYgmea1wm3LKdYtSEV6aGTDWKNrWirFG6jbsqlUo5limGnVd5pyUleN4qwtz7Onm64L0YigTQT9RTtrQUdBKeZNy2iinm3U7N23BUIUkwkaxlFacEsQBFNCKG8qllC2odq7EDz0YvZmkv6UILGGJAaxhSTWkAQmIoWUyp7cOixqgu5v0Z9UEvBiAyBN47sBvzYLaXad8WuvnTP_c_hXQI_GGi3Hr3CCMLjF2zRpQURINeKwLsq6J4SmFaGMlL8Aqum61g</recordid><startdate>20120715</startdate><enddate>20120715</enddate><creator>Dyer, Michael A., B.A</creator><creator>Kelly, Paul J., M.B</creator><creator>Chen, Yu-Hui, M.S., M.P.H</creator><creator>Pinnell, Nancy E., B.A</creator><creator>Claus, Elizabeth B., M.D., Ph.D</creator><creator>Lee, Eudocia Q., M.D., M.P.H</creator><creator>Weiss, Stephanie E., M.D</creator><creator>Arvold, Nils D., M.D</creator><creator>Lin, Nancy U., M.D</creator><creator>Alexander, Brian M., M.D., M.P.H</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20120715</creationdate><title>Importance of Extracranial Disease Status and Tumor Subtype for Patients Undergoing Radiosurgery for Breast Cancer Brain Metastases</title><author>Dyer, Michael A., B.A ; Kelly, Paul J., M.B ; Chen, Yu-Hui, M.S., M.P.H ; Pinnell, Nancy E., B.A ; Claus, Elizabeth B., M.D., Ph.D ; Lee, Eudocia Q., M.D., M.P.H ; Weiss, Stephanie E., M.D ; Arvold, Nils D., M.D ; Lin, Nancy U., M.D ; Alexander, Brian M., M.D., M.P.H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-ea4c57b099520c9eab1fe8a8448c723bb58e79386b8c4b404cbfdc251768b5493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>BRAIN</topic><topic>Brain metastases</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - secondary</topic><topic>Brain Neoplasms - surgery</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - chemistry</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Disease Progression</topic><topic>Extracranial disease</topic><topic>Female</topic><topic>HAZARDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Karnofsky Performance Status</topic><topic>MAMMARY GLANDS</topic><topic>METASTASES</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>NEOPLASMS</topic><topic>PATIENTS</topic><topic>PHENOBARBITAL</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery</topic><topic>RADIOTHERAPY</topic><topic>Retrospective Studies</topic><topic>SURGERY</topic><topic>Treatment Outcome</topic><topic>Tumor Burden</topic><topic>Tumor subtype</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dyer, Michael A., B.A</creatorcontrib><creatorcontrib>Kelly, Paul J., M.B</creatorcontrib><creatorcontrib>Chen, Yu-Hui, M.S., M.P.H</creatorcontrib><creatorcontrib>Pinnell, Nancy E., B.A</creatorcontrib><creatorcontrib>Claus, Elizabeth B., M.D., Ph.D</creatorcontrib><creatorcontrib>Lee, Eudocia Q., M.D., M.P.H</creatorcontrib><creatorcontrib>Weiss, Stephanie E., M.D</creatorcontrib><creatorcontrib>Arvold, Nils D., M.D</creatorcontrib><creatorcontrib>Lin, Nancy U., M.D</creatorcontrib><creatorcontrib>Alexander, Brian M., M.D., M.P.H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dyer, Michael A., B.A</au><au>Kelly, Paul J., M.B</au><au>Chen, Yu-Hui, M.S., M.P.H</au><au>Pinnell, Nancy E., B.A</au><au>Claus, Elizabeth B., M.D., Ph.D</au><au>Lee, Eudocia Q., M.D., M.P.H</au><au>Weiss, Stephanie E., M.D</au><au>Arvold, Nils D., M.D</au><au>Lin, Nancy U., M.D</au><au>Alexander, Brian M., M.D., M.P.H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Importance of Extracranial Disease Status and Tumor Subtype for Patients Undergoing Radiosurgery for Breast Cancer Brain Metastases</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2012-07-15</date><risdate>2012</risdate><volume>83</volume><issue>4</issue><spage>e479</spage><epage>e486</epage><pages>e479-e486</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose In this retrospective study, we report on outcomes and prognostic factors for patients treated with stereotactic radiosurgery (SRS) for breast cancer brain metastases. Methods and Materials We identified 132 consecutive patients with breast cancer who were treated with SRS for brain metastases from January 2000 through June 2010. We retrospectively reviewed records of the 51 patients with adequate follow-up data who received SRS as part of the initial management of their brain metastases. Overall survival (OS) and time to central nervous system (CNS) progression from the date of SRS were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Results Triple negative subtype was associated with CNS progression on univariate analysis (hazard ratio [HR] = 5.0, p = 0.008). On multivariate analysis, triple negative subtype (HR = 8.6, p = 0.001), Luminal B subtype (HR = 4.3, p = 0.03), and omission of whole-brain radiation therapy (HR = 3.7, p = 0.02) were associated with CNS progression. With respect to OS, Karnofsky Performance Status (KPS) ≤ 80% (HR = 2.0, p = 0.04) and progressive extracranial disease (HR = 3.1, p = 0.002) were significant on univariate analysis; KPS ≤ 80% (HR = 4.1, p = 0.0004), progressive extracranial disease (HR = 6.4, p < 0.0001), and triple negative subtype (HR = 2.9, p = 0.04) were significant on multivariate analysis. Although median survival times were consistent with those predicted by the breast cancer-specific Graded Prognostic Assessment (Breast-GPA) score, the addition of extracranial disease status further separated patient outcomes. Conclusions Tumor subtype is associated with risk of CNS progression after SRS for breast cancer brain metastases. In addition to tumor subtype and KPS, which are incorporated into the Breast-GPA, progressive extracranial disease may be an important prognostic factor for OS.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22704705</pmid><doi>10.1016/j.ijrobp.2012.01.054</doi></addata></record> |
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| subjects | Adult Aged BRAIN Brain metastases Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - secondary Brain Neoplasms - surgery Breast cancer Breast Neoplasms - chemistry Breast Neoplasms - drug therapy Disease Progression Extracranial disease Female HAZARDS Hematology, Oncology and Palliative Medicine Humans Karnofsky Performance Status MAMMARY GLANDS METASTASES Middle Aged MULTIVARIATE ANALYSIS NEOPLASMS PATIENTS PHENOBARBITAL Prognosis Proportional Hazards Models Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery RADIOTHERAPY Retrospective Studies SURGERY Treatment Outcome Tumor Burden Tumor subtype |
| title | Importance of Extracranial Disease Status and Tumor Subtype for Patients Undergoing Radiosurgery for Breast Cancer Brain Metastases |
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