Zhang Qian, Chen Jian, Yu Xiaoli, Ma Jinli, Cai Gang, Yang Zhaozhi, Cao Lu, Chen Xingxing, Guo Xiaomao, Chen Jiayi
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China.
J Neurooncol. 2013 Sep;114(2):181-9. doi: 10.1007/s11060-013-1169-4. Epub 2013 Jun 7.
Whole brain radiotherapy (WBRT) is the most widely used treatment for brain metastasis (BM), especially for patients with multiple intracranial lesions. The purpose of this study was to examine the efficacy of systemic treatments following WBRT in breast cancer patients with BM who had different clinical characteristics, based on the classification of the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) and the breast cancer-specific Graded Prognostic Assessment (Breast-GPA). One hundred and one breast cancer patients with BM treated between 2006 and 2010 were analyzed. The median interval between breast cancer diagnosis and identification of BM in the triple-negative patients was shorter than in the luminal A subtype (26 vs. 36 months, respectively; P = 0.021). Univariate analysis indicated that age at BM diagnosis, Karnofsky performance status/recursive partitioning analysis (KPS/RPA) classes, number of BMs, primary tumor control, extracranial metastases and systemic treatment following WBRT were significant prognostic factors for overall survival (OS) (P < 0.05). Multivariate analysis revealed that KPS/RPA classes and systemic treatments following WBRT remained the significant prognostic factors for OS. For RPA class I, the median survival with and without systemic treatments following WBRT was 25 and 22 months, respectively (P = 0.819), while for RPA class II/III systemic treatments significantly improved OS from 7 and 2 months to 11 and 5 months, respectively (P < 0.05). Our results suggested that triple-negative patients had a shorter interval between initial diagnosis and the development of BM than luminal A patients. Systemic treatments following WBRT improved the survival of RPA class II/III patients.
全脑放疗（WBRT）是脑转移瘤（BM）最常用的治疗方法，尤其是对于有多个颅内病灶的患者。本研究的目的是基于放射治疗肿瘤学组递归分区分析（RPA）分类和乳腺癌特异性分级预后评估（Breast-GPA），探讨接受WBRT治疗的不同临床特征的乳腺癌脑转移患者进行全身治疗的疗效。分析了2006年至2010年间接受治疗的101例乳腺癌脑转移患者。三阴性患者从乳腺癌诊断到脑转移确诊的中位间隔时间短于腔面A型患者（分别为26个月和36个月；P = 0.021）。单因素分析表明，脑转移诊断时的年龄、卡氏功能状态/递归分区分析（KPS/RPA）分级、脑转移灶数量、原发肿瘤控制情况、颅外转移以及WBRT后的全身治疗是总生存期（OS）的显著预后因素（P < 0.05）。多因素分析显示，KPS/RPA分级和WBRT后的全身治疗仍然是OS的显著预后因素。对于RPA I级，接受和未接受WBRT后全身治疗的中位生存期分别为25个月和22个月（P = 0.819），而对于RPA II/III级，全身治疗显著改善了OS，分别从7个月和2个月提高到11个月和5个月（P < 0.05）。我们的结果表明，三阴性患者从初始诊断到脑转移发生的间隔时间比腔面A型患者短。WBRT后的全身治疗改善了RPA II/III级患者的生存期。
