Nieder Carsten, Oehlke Oliver, Hintz Mandy, Grosu Anca L
Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodø, Norway ; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany.
Springerplus. 2015 Oct 7;4:585. doi: 10.1186/s40064-015-1384-x. eCollection 2015.
The vast majority of patients with brain metastases from breast cancer have extracranial metastases, e.g., in the liver, lungs or bones, with serious impact on prognosis. Limited research has been performed on patients with brain-only disease. We analyzed patterns of treatment, brain control and survival in uni- and multivariate analyses. All 25 patients with brain-only disease were treated with radiotherapy (whole-brain radiotherapy (WBRT) with or without stereotactic radiotherapy/radiosurgery (SRS) or surgical resection) and most patients with systemic treatment later during the disease trajectory. Only a minority of patients remained free from brain progression at 1 year after their initial therapy, regardless of initial treatment approach (median brain progression-free survival 6.2 months). However, overall survival was significantly better after initial surgical resection/SRS as compared to upfront WBRT (median 24.1 and 5.2 months, respectively). For all patients combined, median survival was 11.7 months (2-year survival rate 28 %). Several prognostic factors for shorter survival were identified in multivariate regression analysis: lower KPS, triple-negative tumor, coordination deficit, older age, lack of upfront surgical resection or SRS, and lack of endocrine or HER2-directed therapy after brain metastases treatment. Although durable brain control and long-term survival beyond 5 years could be achieved in a subset of patients (largely after successful salvage), progression of brain metastases during the first year after diagnosis was common. Prognosis was influenced by patient-, disease- and treatment-related factors.
绝大多数乳腺癌脑转移患者伴有颅外转移，如肝、肺或骨转移，这对预后有严重影响。针对仅脑转移的患者开展的研究有限。我们在单因素和多因素分析中分析了治疗模式、脑转移控制情况及生存情况。所有25例仅脑转移的患者均接受了放疗（全脑放疗（WBRT），联合或不联合立体定向放疗/放射外科手术（SRS）或手术切除），且大多数患者在疾病进程后期接受了全身治疗。无论初始治疗方法如何，仅少数患者在初始治疗后1年无脑转移进展（中位无进展生存期为6.2个月）。然而，与 upfront WBRT相比，初始手术切除/SRS后的总生存期显著更长（分别为24.1个月和5.2个月）。所有患者的中位生存期为11.7个月（2年生存率为28%）。多因素回归分析确定了几个生存期较短的预后因素：KPS较低、三阴性肿瘤、共济失调、年龄较大、未进行 upfront 手术切除或SRS，以及脑转移治疗后未接受内分泌或HER2靶向治疗。尽管部分患者（主要是在成功挽救治疗后）可实现持久的脑转移控制和超过5年的长期生存，但诊断后第1年脑转移进展仍很常见。预后受患者、疾病和治疗相关因素的影响。
