Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, 12631 E. 17th Ave, Aurora, CO, 80045, USA.
Department of Radiation Oncology, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA.
J Neurooncol. 2023 May;163(1):115-121. doi: 10.1007/s11060-023-04314-6. Epub 2023 May 2.
Brain metastases occur in up to one-third of patients with breast cancer. aromatase, a marker for estrogen activity that has been shown to promote such metastasis, heavily concentrates in certain midline structures of brain. We hypothesize that breast cancer metastasizes more often to brain areas with higher aromatase activity and that these patients have a higher risk of developing obstructive hydrocephalus.
In our retrospective review of 709 patients who underwent stereotactic radiosurgery (January 2014-May 2020), we identified 358 patients treated for metastatic breast or lung cancer. The MRI scan that first showed evidence of brain metastases was reviewed and number of metastases counted by location. Procedures used to treat obstructive hydrocephalus were recorded. Chi square test was used for statistical analysis.
Of 358 patients, 99 patients with breast cancer had 618 brain metastases and 259 patients with lung cancer had 1487 brain metastases. Compared with expected distribution of brain metastases based on regional brain volumes and metastatic lung carcinoma as a control, patients with breast cancer more often had metastases to the cerebellum, diencephalon, medulla, and parietal lobe, and underwent significantly more neurosurgical interventions for treatment of obstructive hydrocephalus.
Brain metastases in patients with breast cancer occurred more often along midline structures of the brain, which we believe may be associated with the increased estrogen activity in these structures. This finding is important for physicians who treat patients with metastatic breast cancer given the higher possibility of developing obstructive hydrocephalus.
乳腺癌患者中有多达三分之一会发生脑转移。芳香酶是一种雌激素活性的标志物，已被证明可促进这种转移，它在大脑的某些中线结构中高度集中。我们假设乳腺癌更常转移到芳香酶活性更高的脑区，这些患者发生阻塞性脑积水的风险更高。
我们回顾性分析了 709 例接受立体定向放射外科治疗的患者（2014 年 1 月至 2020 年 5 月），其中 358 例为转移性乳腺癌或肺癌患者。我们对首次显示脑转移证据的 MRI 扫描进行了回顾，并按位置对转移灶的数量进行了计数。记录了用于治疗阻塞性脑积水的程序。采用卡方检验进行统计学分析。
在 358 例患者中，99 例乳腺癌患者有 618 个脑转移灶，259 例肺癌患者有 1487 个脑转移灶。与基于脑区体积和转移性肺癌的预期脑转移分布相比，乳腺癌患者的小脑、间脑、延髓和顶叶更常发生转移，并且需要进行更多的神经外科干预来治疗阻塞性脑积水。
乳腺癌患者的脑转移更常发生在大脑的中线结构，我们认为这可能与这些结构中雌激素活性的增加有关。对于治疗转移性乳腺癌的医生来说，这一发现很重要，因为他们发生阻塞性脑积水的可能性更高。
