Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK.
Clin Oncol (R Coll Radiol). 2020 Jun;32(6):390-396. doi: 10.1016/j.clon.2020.02.007. Epub 2020 Mar 1.
Stereotactic radiosurgery (SRS) is an alternative to surgery or whole brain radiotherapy for the control of single or multiple brain metastases in patients with breast cancer. To date, there is no clear consensus on factors that might predict overall survival following SRS. The aim of this study was to assess the overall survival of breast cancer patients with brain metastases treated with SRS at a single centre and to examine the factors that might influence survival.
A retrospective analysis of consecutive patients with breast cancer and brain metastases, considered suitable for SRS by the regional neuro-oncology multidisciplinary team. All patients were treated at a single National Health Service centre.
In total, 91 patients received SRS between 2013 and 2017, of whom 15 (16.5%) were alive at the time of analysis. The median overall survival post-SRS was 15.7 months (interquartile range 7.7-23.8 months) with no significant effect of age on survival (67 patients ≤ 65 years, 16.3 months; 26 patients > 65 years, 11.4 months, P = 0.129). The primary tumour receptor status was an important determinant of outcome: 31 oestrogen receptor positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) patients had a median overall survival of 13.8 months, 14 ER+/HER2+ patients had a median overall survival of 21.4 months, 30 ER-/HER2+ patients had a median overall survival of 20.4 months and 16 patients with triple negative breast cancer (TNBC) had a median overall survival of 8.5 months. A larger total volume of tumour treated (>10 cm), but not the number of individual metastases treated, was associated with worse survival (P = 0.0002) in this series. Patients with stable extracranial disease at the time of SRS had improved overall survival compared with those with progressive extracranial disease (30 patients stable extracranial disease overall survival = 20.1 months versus 33 patients progressive extracranial disease overall survival = 11.4 months; P = 0.0011). Seventeen patients had no extracranial disease at the time of SRS, with a median overall survival of 13.1 months.
This single-centre series of consecutive patients with brain metastases from breast cancer, treated with SRS, had a similar overall survival compared with previous studies of SRS. TNBC and ER+/HER2- histology, metastatic volumes >10 cm and progressive extracranial disease at the time of SRS were associated with worse survival.
立体定向放射外科（SRS）是手术或全脑放疗的替代方法，可用于控制乳腺癌患者的单发或多发脑转移。迄今为止，对于 SRS 后总生存的预测因素尚无明确共识。本研究的目的是评估在单中心接受 SRS 治疗的乳腺癌脑转移患者的总生存率，并探讨可能影响生存的因素。
对接受 SRS 治疗的乳腺癌和脑转移患者进行回顾性分析，这些患者被区域神经肿瘤多学科小组认为适合 SRS。所有患者均在单一的国家医疗服务中心接受治疗。
在 2013 年至 2017 年间，共有 91 例患者接受了 SRS 治疗，其中 15 例（16.5%）在分析时仍存活。SRS 后中位总生存期为 15.7 个月（四分位距 7.7-23.8 个月），年龄对生存无显著影响（67 例患者≤65 岁，16.3 个月；26 例患者>65 岁，11.4 个月，P=0.129）。肿瘤原发受体状态是预后的重要决定因素：31 例雌激素受体阳性（ER+）/人表皮生长因子受体 2 阴性（HER2-）患者的中位总生存期为 13.8 个月，14 例 ER+/HER2+患者的中位总生存期为 21.4 个月，30 例 ER-/HER2+患者的中位总生存期为 20.4 个月，16 例三阴性乳腺癌（TNBC）患者的中位总生存期为 8.5 个月。与本系列中接受治疗的肿瘤总体积（>10cm）较大但治疗的单个转移灶数量无关，与较差的生存相关（P=0.0002）。在 SRS 时具有稳定颅外疾病的患者的总生存率优于具有进展性颅外疾病的患者（30 例稳定颅外疾病患者的总生存率为 20.1 个月，33 例进展性颅外疾病患者的总生存率为 11.4 个月；P=0.0011）。17 例患者在 SRS 时无颅外疾病，中位总生存期为 13.1 个月。
本研究为单中心连续接受 SRS 治疗的乳腺癌脑转移患者系列，其总生存率与 SRS 治疗的先前研究相似。TNBC 和 ER+/HER2-组织学、转移体积>10cm 和 SRS 时进展性颅外疾病与较差的生存相关。
