Sharma Ashish, Nguyen Ha Son, Lozen Andrew, Sharma Abhishiek, Mueller Wade
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Surg Neurol Int. 2016 Sep 1;7(Suppl 23):S603-6. doi: 10.4103/2152-7806.189730. eCollection 2016.
Brain metastasis during pregnancy is a rare occurrence. In particular, there have only been three prior cases regarding breast cancer metastasis. We report a patient with breast cancer metastasis to the brain during pregnancy and review the literature.
The patient was a 35-year-old female with a history of breast cancer (estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2/neu positive, status post-neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab therapy, status post-bilateral mastectomies), and prior right frontal brain metastases (status post-resection, capecitabine/lapatinib/temozolomide therapy, and cyberknife treatment). Patient was found to be pregnant at 9 weeks' gestation while on chemotherapy; the patient elected to continue with the pregnancy and chemotherapy was discontinued. At 14 weeks' gestation, she returned with recurrent right frontal disease. She was taken for a craniotomy at 16 weeks' gestation, which confirmed metastases. Six weeks later, patient returned with worsening headaches and fatigue, with more recurrent right frontal disease. She was started on decadron and chemotherapy (5-fluorouracil, adriamycin, and cyclophosphamide). Serial magnetic resonance imaging (MRI) demonstrated enlarging right frontal lesions. She underwent a craniotomy at 27 weeks' gestation, and chemotherapy was discontinued promptly. Starting at 30 weeks' gestation, she received whole brain radiation for 2 weeks. Subsequently, she delivered a baby girl via cesarean section at 32 weeks' gestation. At 6 weeks follow-up, an MRI brain demonstrated no new intracranial disease, with stable postoperative findings.
There is a lack of guidelines and clinical consensus on medical and surgical treatment for breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying tumor burden, location, gestational age of the fetus, and patient's preference and symptomatology.
妊娠期脑转移瘤较为罕见。特别是，此前仅有三例关于乳腺癌转移的病例。我们报告一例妊娠期乳腺癌脑转移患者，并对相关文献进行回顾。
该患者为一名35岁女性，有乳腺癌病史（雌激素受体/孕激素受体阴性，人表皮生长因子受体2/neu阳性，接受过新辅助多西他赛/卡铂/曲妥珠单抗/帕妥珠单抗治疗，双侧乳房切除术后），既往有右额叶脑转移病史（切除术后，接受过卡培他滨/拉帕替尼/替莫唑胺治疗及射波刀治疗）。患者在化疗期间妊娠9周；患者选择继续妊娠，化疗停止。妊娠14周时，她因右额叶疾病复发前来就诊。妊娠16周时她接受了开颅手术，确诊为转移瘤。六周后，患者因头痛和疲劳加重前来复诊，右额叶疾病复发更多。她开始使用地塞米松和化疗（5-氟尿嘧啶、阿霉素和环磷酰胺）。系列磁共振成像（MRI）显示右额叶病灶增大。她在妊娠27周时接受了开颅手术，化疗立即停止。从妊娠30周开始，她接受了为期2周的全脑放疗。随后，她在妊娠32周时经剖宫产分娩一名女婴。随访6周时，脑部MRI显示无新的颅内疾病，术后结果稳定。
对于妊娠患者乳腺癌转移的药物和手术治疗，缺乏指南和临床共识。治疗通常根据潜在肿瘤负荷、位置、胎儿孕周、患者偏好和症状而有所不同。
