Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.
University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA.
BMC Cancer. 2021 Mar 4;21(1):223. doi: 10.1186/s12885-021-07971-w.
Due to recent concerns about the toxicity of trastuzumab emtansine (T-DM1) with stereotactic radiation, we assessed our institutional outcomes treating HER2-positive breast cancer brain metastases (BCBM) with T-DM1 and stereotactic radiation.
This is a single institution series of 16 patients with HER2-positive breast cancer who underwent 18 stereotactic sessions to 40 BCBM from 2013 to 2019 with T-DM1 delivered within 6 months. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), distant intracranial control (DIC), and systemic progression-free survival (sPFS) from the date of SRS. A neuro-radiologist independently reviewed follow-up imaging.
One patient had invasive lobular carcinoma, and 15 patients had invasive ductal carcinoma. All cases were HER2-positive, while 10 were hormone receptor (HR) positive. Twenty-four lesions were treated with stereotactic radiosurgery (SRS) to a median dose of 21 Gy (14-24 Gy). Sixteen lesions were treated with fractionated stereotactic radiation (FSRT) with a median dose of 25 Gy (20-30Gy) delivered in 3 to 5 fractions. Stereotactic radiation was delivered concurrently with T-DM1 in 19 lesions (48%). Median follow up time was 13.2 months from stereotactic radiation. The 1-year LC, DIC, sPFS, and OS were 75, 50, 30, and 67%, respectively. There was 1 case of leptomeningeal progression and 1 case (3%) of symptomatic radionecrosis.
We demonstrate that stereotactic radiation and T-DM1 is well-tolerated and effective for patients with HER2-positive BCBM. An increased risk for symptomatic radiation necrosis was not noted in our series.
由于最近人们对曲妥珠单抗-美坦新偶联物（T-DM1）联合立体定向放疗的毒性产生担忧，我们评估了机构内采用 T-DM1 联合立体定向放疗治疗人表皮生长因子受体 2（HER2）阳性乳腺癌脑转移（BCBM）的结果。
这是一项单中心回顾性研究，纳入了 2013 年至 2019 年期间接受 T-DM1 治疗且在 6 个月内行立体定向放疗（SRT）的 16 例 HER2 阳性乳腺癌患者，共对 40 个脑转移瘤（BCBM）进行了 18 次 SRT。采用 Kaplan-Meier 法计算 SRS 后总生存期（OS）、局部控制率（LC）、远处颅内无进展生存期（DIC）和系统性无进展生存期（sPFS）。由一名神经放射科医生独立评估随访影像学结果。
1 例为浸润性小叶癌，15 例为浸润性导管癌。所有病例均为 HER2 阳性，其中 10 例为激素受体（HR）阳性。24 个病灶接受立体定向放疗（SRS），中位剂量为 21 Gy（14-24 Gy）。16 个病灶接受分次立体定向放疗（FSRT），中位剂量为 25 Gy（20-30 Gy），分 3-5 次给予。19 个病灶（48%）同步给予 SRT 和 T-DM1。SRT 后中位随访时间为 13.2 个月。1 年的 LC、DIC、sPFS 和 OS 分别为 75%、50%、30%和 67%。有 1 例发生软脑膜进展，1 例（3%）发生症状性放射性坏死。
我们的研究表明，HER2 阳性 BCBM 患者采用 SRT 和 T-DM1 治疗具有良好的耐受性和有效性。在我们的研究中，并未观察到症状性放射性坏死风险增加。
