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Annals of Oncology 14:1072-1077, 2003
© 2003 European Society for Medical Oncology

Original Paper

Occult central nervous system involvement in patients with metastatic breast cancer: prevalence, predictive factors and impact on overall survival

K. D. Miller1,+, T. Weathers1, L. G. Haney1, R. Timmerman2, M. Dickler3, J. Shen4 and G. W. Sledge Jr1

1 Division of Hematology and Oncology, 2 Department of Radiation Oncology, and 4 Division of Biostatistics, Indiana University, Indianapolis, IN; 3 Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Received 18 July 2002; revised 20 January 2003; accepted 14 March 2003

Background:

As screening central nervous system (CNS) imaging is not routinely performed, the incidence and clinical relevance of occult CNS metastases in advanced breast cancer is unknown.

Patients and methods:

All patients screened for participation in one of four clinical trials were included; each of the trials excluded patients with known CNS involvement and required screening CNS imaging. A cohort of breast cancer patients with symptomatic CNS metastases was identified from the IU Cancer Center Tumor Registry for comparison.

Results:

From November 1998 to August 2001, 155 screening imaging studies were performed. Twenty-three patients (14.8%) had occult CNS metastases. HER-2 overexpression (P = 0.02) and number of metastatic sites (P = 0.03) were predictive of CNS involvement by multivariate analysis. Median survival from time of metastasis (1.78 versus 2.76 years; P <0.0001) and from screening (4.67 versus 10.4 months; P = 0.0013) was shorter in patients with than without occult CNS metastasis. Survival among patients with occult CNS metastasis was similar to patients with symptomatic CNS disease.

Conclusions:

Patients with CNS involvement, whether occult or symptomatic, have an impaired survival. Occult CNS metastasis is relatively common, but impact on survival of treating occult CNS disease in patients with progressive systemic metastases is questionable.

Key words: breast cancer, central nervous system, metastasis, natural history


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