Mashiach Elad, Alzate Juan Diego, De Nigris Vasconcellos Fernando, Bernstein Kenneth, Donahue Bernadine R, Schnurman Zane, Gurewitz Jason, Rotman Lauren E, Adams Sylvia, Meyers Marleen, Oratz Ruth, Novik Yelena, Kwa Maryann J, Silverman Joshua S, Sulman Erik P, Golfinos John G, Kondziolka Douglas
Department of Neurological Surgery, NYU Langone Health, New York University, New York , New York , USA.
Department of Radiation Oncology, NYU Langone Health, New York University, New York , New York , USA.
Neurosurgery. 2024 Jan 1;94(1):154-164. doi: 10.1227/neu.0000000000002640. Epub 2023 Aug 15.
Median survival for all patients with breast cancer with brain metastases (BCBMs) has increased in the era of targeted therapy (TT) and with improved local control of intracranial tumors using stereotactic radiosurgery (SRS) and surgical resection. However, detailed characterization of the patients with long-term survival in the past 5 years remains sparse. The aim of this article is to characterize patients with BCBM who achieved long-term survival and identify factors associated with the uniquely better outcomes and to find predictors of mortality for patients with BCBM.
We reviewed 190 patients with breast cancer with 931 brain tumors receiving SRS who were followed at our institution with prospective data collection between 2012 and 2022. We analyzed clinical, molecular, and imaging data to assess relationship to outcomes and tumor control.
The median overall survival from initial SRS and from breast cancer diagnosis was 25 months (95% CI 19-31 months) and 130 months (95% CI 100-160 months), respectively. Sixteen patients (17%) achieved long-term survival (survival ≥5 years from SRS), 9 of whom are still alive. Predictors of long-term survival included HER2+ status ( P = .041) and treatment with TT ( P = .046). A limited number of patients (11%) died of central nervous system (CNS) causes. A predictor of CNS-related death was the development of leptomeningeal disease after SRS ( P = .025), whereas predictors of non-CNS death included extracranial metastases at first SRS ( P = .017), triple-negative breast cancer ( P = .002), a Karnofsky Performance Status of <80 at first SRS ( P = .002), and active systemic disease at last follow-up ( P = .001). Only 13% of patients eventually needed whole brain radiotherapy. Among the long-term survivors, none died of CNS progression.
Patients with BCBM can achieve long-term survival. The use of TT and HER2+ disease are associated with long-term survival. The primary cause of death was extracranial disease progression, and none of the patients living ≥5 years died of CNS-related disease.
在靶向治疗时代以及使用立体定向放射外科（SRS）和手术切除改善颅内肿瘤局部控制的情况下，所有脑转移乳腺癌（BCBM）患者的中位生存期有所延长。然而，过去5年长期生存患者的详细特征仍然缺乏。本文旨在描述实现长期生存的BCBM患者的特征，确定与独特更好结局相关的因素，并寻找BCBM患者的死亡预测因素。
我们回顾了190例患有931个脑肿瘤并接受SRS治疗的乳腺癌患者，这些患者于2012年至2022年在我们机构接受前瞻性数据收集随访。我们分析了临床、分子和影像数据，以评估与结局和肿瘤控制的关系。
首次SRS后的中位总生存期和乳腺癌诊断后的中位总生存期分别为25个月（95%CI 19 - 31个月）和130个月（95%CI 10
