Saisho Shinsuke, Takashima Shigemitsu, Ohsumi Shozo, Saeki Hideyuki, Aogi Kenjiro, Saeki Toshiaki, Mandai Koich, Iwata Shinji, Takeda Tetsuji
Department of Surgery, Unnan Municipal General Hospital, 96-1 Iida, Daito-chou, Unnan-city, Shimane 699-1221, Japan.
Breast Cancer. 2005;12(3):221-5. doi: 10.2325/jbcs.12.221.
Two rare cases, each with a solitary brain metastasis from breast cancer with extensive nodal metastases as the first site of distant metastasis, were locally treated with surgery and irradiation. The outcome of the two treated cases indicated an excellent and non-recurrent post-therapeutic survival period of more than 3 and 8 years, respectively. In a 50-year-old woman (Case 1), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with doxorubicin and tegafur-uracil (UFT) and hormonal therapy with tamoxifen for left breast cancer. The brain metastasis was treated twice surgically followed by radiotherapy. One year and 6 months later, local recurrence of the brain metastasis appeared and was treated surgically again. No other treatment was done thereafter. Since then, no other distant or lymph node metastasis occurred, and to date her outcome has been non-eventful for 8 years and 5 months. In a 63-year-old woman (Case 2), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with cyclophosphamide, epirubicin and fluorouracil (CEF) for right breast cancer. The brain metastasis was treated locally with surgery and irradiation of 50 Gy. She thereafter received no further treatments. Since then neither distant metastases nor local recurrence have developed, and to date the post-treatment outcome has been uneventful for 37 months. Our findings suggest that patients who developed a solitary brain metastasis as the first site of distant metastasis from breast cancer have a chance of achieving long-term disease-free survival when treated with aggressive local therapy, even in the presence of extensive lymph node metastases at the primary surgery site for breast cancer.
两例罕见病例，均为乳腺癌单发脑转移，且均以广泛的淋巴结转移作为远处转移的首发部位，均接受了手术和放疗的局部治疗。这两例经治疗的病例结果显示，治疗后的生存期分别超过3年和8年，效果良好且无复发。在一名50岁女性（病例1）中，左乳腺癌在接受标准根治性乳房切除术、多柔比星和替加氟-尿嘧啶（UFT）辅助化疗以及他莫昔芬激素治疗后，发现出现了单发脑转移。该脑转移灶接受了两次手术治疗，随后进行了放疗。1年零6个月后，脑转移灶出现局部复发并再次接受手术治疗。此后未进行其他治疗。从那时起，未出现其他远处或淋巴结转移，迄今为止，她已平安度过8年零5个月。在一名63岁女性（病例2）中，右乳腺癌在接受标准根治性乳房切除术、环磷酰胺、表柔比星和氟尿嘧啶（CEF）辅助化疗后，发现出现了单发脑转移。该脑转移灶接受了手术及50 Gy的放疗局部治疗。此后她未再接受进一步治疗。从那时起，既未出现远处转移也未出现局部复发，迄今为止，治疗后的结果已平安度过37个月。我们的研究结果表明，乳腺癌患者以单发脑转移作为远处转移的首发部位时，即使在乳腺癌原发手术部位存在广泛淋巴结转移的情况下，积极进行局部治疗仍有机会实现长期无病生存。
