Survival following gamma knife radiosurgery for brain metastasis from breast cancer

Jerry J. Jaboin, Daniel J. Ferraro, Todd DeWees, Keith M. Rich, Michael R. Chicoine, Joshua L. Dowling, David B. Mansur, Robert E. Drzymala, Joseph R. Simpson, William J. Magnuson, Anushka H. Patel, Imran Zoberi

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Breast cancer is the second most common cause of brain metastases in the United States. Although breast cancer induced brain metastases represent an incurable condition, some patients experience prolonged survival. In this retrospective study, we examine a cohort of patients with brain metastases from breast cancer treated with Gamma Knife stereotactic radiosurgery to identify factors that predict better outcomes.Methods: A retrospective database of 100 patients treated for brain metastases due to breast cancer via Gamma Knife radiosurgery (GKS) from July 1998 through March 2009 was reviewed. Patients who received radiosurgery as sole treatment, as a planned boost after whole brain radiotherapy or surgical resection, or as salvage after prior whole brain radiation therapy (WBRT) or surgical resection were included. Prognostic factors identified to be significant for survival in previous brain metastasis studies were analyzed for significance by univariate and multivariate Cox analysis.Results: Overall, the median brain progression-free survival time was 7.1 months and the median survival time was 12.3 months. No prognostic variables were significant for brain progression-free survival. For patients treated with a planned GKS after WBRT, GKS as sole treatment, GKS salvage after WBRT, GKS boost after surgery, or GKS for surgical salvage the median survival times (MSTs) were as follows: 12.2 months, 12.4 months, 9.5 months, 27.6 months and 33.4 months respectively. Differences between the groups were not significant (p = 0.06); however, GKS boost after surgery and GKS for salvage after surgery did have a trend toward better overall survival.The MST for patients of age <65 years was 14.5 months, compared to age ≥65 which was 7.7 months (p = 0.06) and remained a significant prognostic factor for overall survival on multivariate analysis. The MST for patients with a single lesion was 16.9 months, not significantly different than the MST of 14.5 months for patients with 2-3 lesions. However patients with >3 lesions had a MST of 5.9 months, which was significantly worse. Breast cancer subtype as approximated by biomarkers and KPS were not significant predictors of overall survival and stage at initial diagnosis was inversely associated with survival.Conclusion: Stereotactic radiosurgery offers good local control and prolonged survival in selected patients. Age and number of lesions are strong predictors of overall survival.

Original languageEnglish (US)
Article number131
JournalRadiation Oncology
Volume8
Issue number1
DOIs
StatePublished - May 29 2013
Externally publishedYes

Fingerprint

Radiosurgery
Breast Neoplasms
Neoplasm Metastasis
Survival
Brain
Radiotherapy
Disease-Free Survival
Brain Neoplasms
Multivariate Analysis
Retrospective Studies
Biomarkers
Databases

Keywords

  • Brain metastasis
  • Breast cancer
  • Gamma knife
  • GKS
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Jaboin, J. J., Ferraro, D. J., DeWees, T., Rich, K. M., Chicoine, M. R., Dowling, J. L., ... Zoberi, I. (2013). Survival following gamma knife radiosurgery for brain metastasis from breast cancer. Radiation Oncology, 8(1), [131]. https://doi.org/10.1186/1748-717X-8-131

Survival following gamma knife radiosurgery for brain metastasis from breast cancer. / Jaboin, Jerry J.; Ferraro, Daniel J.; DeWees, Todd; Rich, Keith M.; Chicoine, Michael R.; Dowling, Joshua L.; Mansur, David B.; Drzymala, Robert E.; Simpson, Joseph R.; Magnuson, William J.; Patel, Anushka H.; Zoberi, Imran.

In: Radiation Oncology, Vol. 8, No. 1, 131, 29.05.2013.

Research output: Contribution to journalArticle

Jaboin, JJ, Ferraro, DJ, DeWees, T, Rich, KM, Chicoine, MR, Dowling, JL, Mansur, DB, Drzymala, RE, Simpson, JR, Magnuson, WJ, Patel, AH & Zoberi, I 2013, 'Survival following gamma knife radiosurgery for brain metastasis from breast cancer', Radiation Oncology, vol. 8, no. 1, 131. https://doi.org/10.1186/1748-717X-8-131
Jaboin, Jerry J. ; Ferraro, Daniel J. ; DeWees, Todd ; Rich, Keith M. ; Chicoine, Michael R. ; Dowling, Joshua L. ; Mansur, David B. ; Drzymala, Robert E. ; Simpson, Joseph R. ; Magnuson, William J. ; Patel, Anushka H. ; Zoberi, Imran. / Survival following gamma knife radiosurgery for brain metastasis from breast cancer. In: Radiation Oncology. 2013 ; Vol. 8, No. 1.
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AU - Ferraro, Daniel J.

AU - DeWees, Todd

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AU - Chicoine, Michael R.

AU - Dowling, Joshua L.

AU - Mansur, David B.

AU - Drzymala, Robert E.

AU - Simpson, Joseph R.

AU - Magnuson, William J.

AU - Patel, Anushka H.

AU - Zoberi, Imran

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N2 - Background: Breast cancer is the second most common cause of brain metastases in the United States. Although breast cancer induced brain metastases represent an incurable condition, some patients experience prolonged survival. In this retrospective study, we examine a cohort of patients with brain metastases from breast cancer treated with Gamma Knife stereotactic radiosurgery to identify factors that predict better outcomes.Methods: A retrospective database of 100 patients treated for brain metastases due to breast cancer via Gamma Knife radiosurgery (GKS) from July 1998 through March 2009 was reviewed. Patients who received radiosurgery as sole treatment, as a planned boost after whole brain radiotherapy or surgical resection, or as salvage after prior whole brain radiation therapy (WBRT) or surgical resection were included. Prognostic factors identified to be significant for survival in previous brain metastasis studies were analyzed for significance by univariate and multivariate Cox analysis.Results: Overall, the median brain progression-free survival time was 7.1 months and the median survival time was 12.3 months. No prognostic variables were significant for brain progression-free survival. For patients treated with a planned GKS after WBRT, GKS as sole treatment, GKS salvage after WBRT, GKS boost after surgery, or GKS for surgical salvage the median survival times (MSTs) were as follows: 12.2 months, 12.4 months, 9.5 months, 27.6 months and 33.4 months respectively. Differences between the groups were not significant (p = 0.06); however, GKS boost after surgery and GKS for salvage after surgery did have a trend toward better overall survival.The MST for patients of age <65 years was 14.5 months, compared to age ≥65 which was 7.7 months (p = 0.06) and remained a significant prognostic factor for overall survival on multivariate analysis. The MST for patients with a single lesion was 16.9 months, not significantly different than the MST of 14.5 months for patients with 2-3 lesions. However patients with >3 lesions had a MST of 5.9 months, which was significantly worse. Breast cancer subtype as approximated by biomarkers and KPS were not significant predictors of overall survival and stage at initial diagnosis was inversely associated with survival.Conclusion: Stereotactic radiosurgery offers good local control and prolonged survival in selected patients. Age and number of lesions are strong predictors of overall survival.

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KW - Brain metastasis

KW - Breast cancer

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