Pikis Stylianos, Mantziaris Georgios, Protopapa Maria, Tos Salem M, Kowalchuk Roman O, Ross Richard Blake, Rusthoven Chad G, Tripathi Manjul, Langlois Anne-Marie, Mathieu David, Lee Cheng-Chia, Yang Huai-Che, Peker Selcuk, Samanci Yavuz, Zhang Michael Yu, Braunstein Steve E, Wei Zhishuo, Niranjan Ajay, Lunsford Dade L, Sheehan Jason
Department of Radiotherapy and Stereotactic Radiosurgery, Mediterraneo Hospital, Athens, Greece.
Department of Neurological Surgery, University of Virginia Health System, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA.
J Neurooncol. 2024 Oct;170(1):199-208. doi: 10.1007/s11060-024-04775-3. Epub 2024 Aug 27.
To report patient outcomes and local tumor control rates in a cohort of patients with biopsy-proven HER-2 positive breast cancer treated with stereotactic radiosurgery (SRS) for brain metastases (BM).
This international, retrospective, multicenter study, included 195 female patients with 1706 SRS-treated BM. Radiologic and clinical outcomes after SRS were determined and prognostic factors identified.
At SRS, median patient age was 55 years [interquartile range (IQR) 47.6-62.0], and 156 (80%) patients had KPS ≥ 80. The median tumor volume was 0.1 cm (IQR 0.1-0.5) and the median prescription dose was 16 Gy (IQR 16-18). Local tumor control (LTC) rate was 98%, 94%, 93%, 90%, and 88% at six-, 12-, 24-, 36- and 60-months post-SRS, respectively. On multivariate analysis, tumor volume (p = < 0.001) and concurrent pertuzumab (p = 0.02) improved LTC. Overall survival (OS) rates at six-, 12-, 24-, 36-, 48-, and 60-months were 90%, 69%, 46%, 27%, 22%, and 18%, respectively. Concurrent pertuzumab improved OS (p = 0.032). In this patient subgroup, GPA scores ≥ 2.5 (p = 0.038 and p = 0.003) and rare primary tumor histologies (p = 0.01) were associated with increased and decreased OS, respectively. Asymptomatic adverse radiation events (ARE) occurred in 27 (14.0%) and symptomatic ARE in five (2.6%) patients. Invasive lobular carcinoma primary (p = 0.042) and concurrent pertuzumab (p < 0.001) conferred an increased risk for overall but not for symptomatic ARE.
SRS affords effective LTC for selected patients with BM from HER-2 positive breast cancer. Concurrent pertuzumab improved LTC and OS but at the same time increased the risk for overall, but not symptomatic, ARE.
报告一组经活检证实为HER-2阳性乳腺癌且接受立体定向放射外科治疗（SRS）的脑转移（BM）患者的治疗效果及局部肿瘤控制率。
这项国际、回顾性、多中心研究纳入了195例女性患者的1706个接受SRS治疗的脑转移灶。确定SRS后的影像学和临床结局，并确定预后因素。
在进行SRS时，患者中位年龄为55岁[四分位间距（IQR）47.6 - 62.0]，156例（80%）患者的KPS≥80。肿瘤中位体积为0.1 cm（IQR 0.1 - 0.5），中位处方剂量为16 Gy（IQR 16 - 18）。SRS后6个月、12个月、24个月、36个月和60个月时的局部肿瘤控制（LTC）率分别为98%、94%、93%、90%和88%。多因素分析显示，肿瘤体积（p = < 0.001）和同时使用帕妥珠单抗（p = 0.02）可改善LTC。6个月、12个月、24个月、36个月、48个月和60个月时的总生存率（OS）分别为90%、69%、46%、27%、22%和18%。同时使用帕妥珠单抗可改善OS（p = 0.032）。在该患者亚组中，GPA评分≥2.5（p = 0.038和p = 0.003）和少见的原发肿瘤组织学类型（p = 0.01）分别与OS升高和降低相关。无症状放射性不良事件（ARE）发生在27例（14.0%）患者中，有症状的ARE发生在5例（2.6%）患者中。原发性浸润性小叶癌（p = 0.042）和同时使用帕妥珠单抗（p < 0.001）使总体ARE风险增加，但不增加有症状ARE的风险。
对于部分HER-2阳性乳腺癌脑转移患者，SRS可提供有效的LTC。同时使用帕妥珠单抗可改善LTC和OS，但同时增加了总体ARE的风险，而非有症状ARE的风险。
