Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery

T. Jonathan Yang, Jung Hun Oh, Michael R. Folkert, Gaorav Gupta, Weiji Shi, Zhigang Zhang, Aki Morikawa, Andrew Seidman, Cameron Brennan, Yoshiya Yamada, Timothy A. Chan, Kathryn Beal

Research output: Contribution to journalArticle

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Abstract

Background: With the continuing increase in the use of definitive stereotactic radiosurgery(SRS) for patients with limited brain metastases (BM), clinicians need morespecific prognostic tools. We investigated clinical predictors of outcomes in patientswith limited breast cancer BM treated with SRS alone.

Methods and Materials: We identified 136 patients with breast cancer and 1-3 BMwho underwent definitive SRS for 186 BM between 2000 and 2012. The Kaplan-Meier method was used to assess overall survival (OS), regional failure (RF), and localfailure (LF). Associations between clinical factors and outcomes were tested usingCox regression. A point scoring system was used to stratify patients based on OS,and the predictive power was tested with concordance probability estimate (CPE).

Results: The median OS was 17.6 months. The 12-month RF and LF rates were 45%and 10%, respectively. On multivariate analysis, >1 lesion (hazard ratio [HR] = 1.6,P=.02), triple-negative (TN) disease (HR=2.0, P=.006), and active extracranialdisease (ED) (HR=2.7, P<.0001) were significantly associated with worse OS. Thepoint score system was defined using proportional simplification of the multivariateCox proportional hazards regression function. The median OS for patients with3.0-4.0 points (n=37), 4.5-5.5 points (n=28), 6.0-6.5 points (n=37), and 8-8.5 points(n=34) were 9.2, 15.6, 25.1, and 45.1 months, respectively (P<.0001, CPE = 0.72).Active ED (HR=2.4, PZ.0007) was significantly associated with RF. Higher risk forLF was significantly associated with larger BM size (HR=3.1, P=.0001).

Conclusion: Patients with >1 BM, active ED, and TN had the highest risk of deathafter SRS. Active ED is an important prognostic factor for OS and intracranial control.

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume90
Issue number3
DOIs
StatePublished - Nov 1 2014

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Radiosurgery
metastasis
Brain Neoplasms
breast
brain
Breast
cancer
hazards
Neoplasm Metastasis
Survival
Brain
scoring
lesions
regression analysis
Multivariate Analysis
Breast Neoplasms
estimates
predictions

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

Cite this

Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery. / Yang, T. Jonathan; Oh, Jung Hun; Folkert, Michael R.; Gupta, Gaorav; Shi, Weiji; Zhang, Zhigang; Morikawa, Aki; Seidman, Andrew; Brennan, Cameron; Yamada, Yoshiya; Chan, Timothy A.; Beal, Kathryn.

In: International Journal of Radiation Oncology Biology Physics, Vol. 90, No. 3, 01.11.2014, p. 518-525.

Research output: Contribution to journalArticle

Yang, T. Jonathan ; Oh, Jung Hun ; Folkert, Michael R. ; Gupta, Gaorav ; Shi, Weiji ; Zhang, Zhigang ; Morikawa, Aki ; Seidman, Andrew ; Brennan, Cameron ; Yamada, Yoshiya ; Chan, Timothy A. ; Beal, Kathryn. / Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 90, No. 3. pp. 518-525.
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abstract = "Background: With the continuing increase in the use of definitive stereotactic radiosurgery(SRS) for patients with limited brain metastases (BM), clinicians need morespecific prognostic tools. We investigated clinical predictors of outcomes in patientswith limited breast cancer BM treated with SRS alone.Methods and Materials: We identified 136 patients with breast cancer and 1-3 BMwho underwent definitive SRS for 186 BM between 2000 and 2012. The Kaplan-Meier method was used to assess overall survival (OS), regional failure (RF), and localfailure (LF). Associations between clinical factors and outcomes were tested usingCox regression. A point scoring system was used to stratify patients based on OS,and the predictive power was tested with concordance probability estimate (CPE).Results: The median OS was 17.6 months. The 12-month RF and LF rates were 45{\%}and 10{\%}, respectively. On multivariate analysis, >1 lesion (hazard ratio [HR] = 1.6,P=.02), triple-negative (TN) disease (HR=2.0, P=.006), and active extracranialdisease (ED) (HR=2.7, P<.0001) were significantly associated with worse OS. Thepoint score system was defined using proportional simplification of the multivariateCox proportional hazards regression function. The median OS for patients with3.0-4.0 points (n=37), 4.5-5.5 points (n=28), 6.0-6.5 points (n=37), and 8-8.5 points(n=34) were 9.2, 15.6, 25.1, and 45.1 months, respectively (P<.0001, CPE = 0.72).Active ED (HR=2.4, PZ.0007) was significantly associated with RF. Higher risk forLF was significantly associated with larger BM size (HR=3.1, P=.0001).Conclusion: Patients with >1 BM, active ED, and TN had the highest risk of deathafter SRS. Active ED is an important prognostic factor for OS and intracranial control.",
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T1 - Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery

AU - Yang, T. Jonathan

AU - Oh, Jung Hun

AU - Folkert, Michael R.

AU - Gupta, Gaorav

AU - Shi, Weiji

AU - Zhang, Zhigang

AU - Morikawa, Aki

AU - Seidman, Andrew

AU - Brennan, Cameron

AU - Yamada, Yoshiya

AU - Chan, Timothy A.

AU - Beal, Kathryn

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Background: With the continuing increase in the use of definitive stereotactic radiosurgery(SRS) for patients with limited brain metastases (BM), clinicians need morespecific prognostic tools. We investigated clinical predictors of outcomes in patientswith limited breast cancer BM treated with SRS alone.Methods and Materials: We identified 136 patients with breast cancer and 1-3 BMwho underwent definitive SRS for 186 BM between 2000 and 2012. The Kaplan-Meier method was used to assess overall survival (OS), regional failure (RF), and localfailure (LF). Associations between clinical factors and outcomes were tested usingCox regression. A point scoring system was used to stratify patients based on OS,and the predictive power was tested with concordance probability estimate (CPE).Results: The median OS was 17.6 months. The 12-month RF and LF rates were 45%and 10%, respectively. On multivariate analysis, >1 lesion (hazard ratio [HR] = 1.6,P=.02), triple-negative (TN) disease (HR=2.0, P=.006), and active extracranialdisease (ED) (HR=2.7, P<.0001) were significantly associated with worse OS. Thepoint score system was defined using proportional simplification of the multivariateCox proportional hazards regression function. The median OS for patients with3.0-4.0 points (n=37), 4.5-5.5 points (n=28), 6.0-6.5 points (n=37), and 8-8.5 points(n=34) were 9.2, 15.6, 25.1, and 45.1 months, respectively (P<.0001, CPE = 0.72).Active ED (HR=2.4, PZ.0007) was significantly associated with RF. Higher risk forLF was significantly associated with larger BM size (HR=3.1, P=.0001).Conclusion: Patients with >1 BM, active ED, and TN had the highest risk of deathafter SRS. Active ED is an important prognostic factor for OS and intracranial control.

AB - Background: With the continuing increase in the use of definitive stereotactic radiosurgery(SRS) for patients with limited brain metastases (BM), clinicians need morespecific prognostic tools. We investigated clinical predictors of outcomes in patientswith limited breast cancer BM treated with SRS alone.Methods and Materials: We identified 136 patients with breast cancer and 1-3 BMwho underwent definitive SRS for 186 BM between 2000 and 2012. The Kaplan-Meier method was used to assess overall survival (OS), regional failure (RF), and localfailure (LF). Associations between clinical factors and outcomes were tested usingCox regression. A point scoring system was used to stratify patients based on OS,and the predictive power was tested with concordance probability estimate (CPE).Results: The median OS was 17.6 months. The 12-month RF and LF rates were 45%and 10%, respectively. On multivariate analysis, >1 lesion (hazard ratio [HR] = 1.6,P=.02), triple-negative (TN) disease (HR=2.0, P=.006), and active extracranialdisease (ED) (HR=2.7, P<.0001) were significantly associated with worse OS. Thepoint score system was defined using proportional simplification of the multivariateCox proportional hazards regression function. The median OS for patients with3.0-4.0 points (n=37), 4.5-5.5 points (n=28), 6.0-6.5 points (n=37), and 8-8.5 points(n=34) were 9.2, 15.6, 25.1, and 45.1 months, respectively (P<.0001, CPE = 0.72).Active ED (HR=2.4, PZ.0007) was significantly associated with RF. Higher risk forLF was significantly associated with larger BM size (HR=3.1, P=.0001).Conclusion: Patients with >1 BM, active ED, and TN had the highest risk of deathafter SRS. Active ED is an important prognostic factor for OS and intracranial control.

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