Department of Radiation oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Radiation Oncology, Institut Curie, Paris, France.
Breast J. 2019 Nov;25(6):1134-1142. doi: 10.1111/tbj.13426. Epub 2019 Jul 8.
In this study, we attempted to assess the efficacy of upfront brain radiotherapy (RT) in breast cancer (BC) patients with brain metastases (BM). Medical records of 111 consecutive BC patients treated with WBRT or SRS between August 2009 and November 2017 in single center were retrospectively reviewed. Eighty patients received upfront brain RT after BM diagnosis and 31 had delayed RT. The median age at BM was 54 years (22-77), with median KPS 80 (50-90). The molecular BC subtypes of Luminal A, Luminal B, triple-negative and HER2 overexpression were 16, 47, 27, and 19, respectively, with 2 unknown. Of them, 83 received WBRT after BM and 28 SRS. Median overall survival (OS) was significantly related to Breast-GPA, as following: 6.5, 9.9, 14.4, and 24.5 months in 0-1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 subgroups, respectively (P = 0.007). Univariate and multivariate analysis showed that KPS ≤70, infratentorial involvement, extracranial metastases, and no continuing systemic therapy were independent risk factors for OS. In the whole group, no significant difference in OS was found between upfront or delayed RT. For Breast-GPA 0-2.0 subgroup, upfront RT was associated with increased median OS (3.3 vs 9.8 months, P = 0.04). In GPA 2.5-4.0 subgroup, the median OS for upfront and delayed RT was 13.8 and 16.5 months, respectively (P = 0.58). In conclusion, BCBM patients with better KPS, systemic therapy, without infratentorial involvement and extracranial metastases are associated with better OS. Patients with Breast-GPA 0-2.0 might benefit from upfront brain RT.
在这项研究中，我们试图评估乳腺癌（BC）伴脑转移（BM）患者接受 upfront 脑部放疗（RT）的疗效。回顾性分析了 2009 年 8 月至 2017 年 11 月在单中心接受全脑放疗（WBRT）或立体定向放疗（SRS）的 111 例连续 BC 患者的病历。80 例患者在 BM 诊断后接受 upfront 脑 RT，31 例患者接受延迟 RT。BM 时的中位年龄为 54 岁（22-77），中位 KPS 为 80（50-90）。Luminal A、Luminal B、三阴性和 HER2 过表达型的分子 BC 亚型分别为 16、47、27 和 19，其中 2 种未知。其中，83 例患者在 BM 后接受 WBRT，28 例患者接受 SRS。中位总生存期（OS）与 Breast-GPA 显著相关，具体如下：0-1.0、1.5-2.0、2.5-3.0 和 3.5-4.0 亚组的 6.5、9.9、14.4 和 24.5 个月（P=0.007）。单因素和多因素分析显示，KPS≤70、幕下受累、颅外转移和无持续全身治疗是 OS 的独立危险因素。在整个队列中， upfront 或延迟 RT 对 OS 无显著影响。对于 Breast-GPA 0-2.0 亚组，upfront RT 与中位 OS 延长相关（3.3 与 9.8 个月，P=0.04）。在 GPA 2.5-4.0 亚组中， upfront 和延迟 RT 的中位 OS 分别为 13.8 和 16.5 个月（P=0.58）。总之，KPS、全身治疗、无幕下受累和颅外转移的 BCBM 患者与更好的 OS 相关。Breast-GPA 0-2.0 的患者可能从 upfront 脑部 RT 中获益。
