Source: DGNews  |  Posted 1 year ago

By Liz Meszaros

PHILADELPHIA -- May 6, 2010 -- Stereotactic radiosurgery (SRS) is safe and effective for select patients with brain metastases from breast cancer, researchers said here on May 4 at the 2010 Annual Meeting of the American Association of Neurological Surgeons (AANS).

"Historically, the mainstay of treatment for brain metastases has been surgical resection or whole brain radiation therapy," said Gillian Harrison, a student at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. "Unfortunately, whole brain radiation therapy has been associated with significant toxicity, which has prompted many to question its role as primary management. More recently, SRS has emerged as a treatment modality for brain metastases, either alone or in conjunction with other methods."

To evaluate the role of SRS in the primary management of brain metastases from breast cancer, Harrison and colleagues assessed clinical outcomes and prognostic factors for survival, cerebral disease control, and morbidity.

They retrospectively reviewed records from 350 consecutive females who underwent SRS for the management of brain metastases (n = 1,535). A total of 117 patients (33%) had single brain metastases, and 233 patients (67%) had multiple brain metastases. Median number of tumours per patient was 2, median tumour volume was 0.7 mL (range, 0.01-48.9 mL), and median total tumour volume for each patient was 4.9 mL (range, 0.09-74.1 mL).

Overall survival 6 months after SRS was 69%. At 12 months, it was 49%, and at 24 months, it was 26% (median survival was 11.2 months). Controlled extracranial disease, lower recursive partitioning analysis (RPA) class, higher Karnofsky Performance Status Scale scores, smaller tumour volume, deep cerebral metastases, brainstem metastases, and human epidermal growth factor receptor 2 (HER2)/neu over-expression were all associated with longer survival.

Patient classification in a lower RPA class caused a significant increase in overall survival time. Patients in RPA class 1 had a median survival of 16.6 months; those in class 2, a median survival of 11.2 months; and those in class 3, only 3.9 months.

Median distant brain metastases-free time was 11.6 months after SRS. Controlled extracranial disease, fewer metastases, and lung metastases were all associated with longer time without additional brain tumours.

Sustained local tumour control was achieved in 90%. Overall, 82% of patients improved or remained neurologically stable. Symptomatic radiation effects occurred in 6%.

"Our study has shown that SRS is effective as primary management for both initial and recurrent brain metastases from breast cancer, and allows extracranial management to continue uninterrupted," Harrison noted. "Unfortunately, the current role and timing of SRS for brain metastases from breast cancer remains unknown."

[Presentation title: The Value of Stereotactic Radiosurgery as Primary Management for Brain Metastases From Breast Cancer]