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Annals of Oncology Advance Access published online on October 19, 2009
Annals of Oncology, doi:10.1093/annonc/mdp407
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT)

A. Niwinska1,*, M. Murawska2 and K. Pogoda1

1 Department of Breast Cancer and Reconstructive Surgery
2 Department of Biostatistics, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland

* Correspondence to: Dr A. Niwinska, Department of Breast Cancer and Reconstructive Surgery, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 02-781 Warszawa, ul. Roentgena 5, Poland. Tel: +48-22-644-00-24; Fax: +48-22-644-00-24; E-mail: alphaonetau{at}poczta.onet.pl

Background: Patients with breast cancer brain metastasis are a heterogeneous group in relation to tumor biology and outcome.

Materials and methods: The group of 222 breast cancer patients with brain metastasis was divided into three biological subgroups. The propensity of biological subtypes for metastases to the brain and survivals depending on biological subtype, recursive partitioning analysis of Radiation Therapy Oncology Group (RPA RTOG) prognostic class and the use of systemic treatment after whole-brain radiotherapy were assessed.

Results: The rate of patients with triple-negative, human epidermal growth factor receptor 2 (HER2)-positive and luminal breast cancer with brain metastases was 28%, 53% and 19%, respectively. Median survival from brain metastases in triple-negative, HER2-positive and luminal subtype was 3.7, 9 and 15 months, respectively. Median survival from brain metastases in RPA RTOG prognostic class I, II and III was 15, 11 and 3 months, respectively. In the luminal and in the triple-negative subtype, systemic therapy prolonged survival from 3 to 14 months and from 3 to 4 months, respectively. In HER2-positive subtype, median survival without further treatment, after chemotherapy and after chemotherapy with targeted therapy were 3, 8 and 11 months, respectively.

Conclusions: HER2-positive and triple-negative breast cancers have special predilection for metastases to the brain. Survival from brain metastases depended on performance status and the use of systemic treatment.

brain metastasis, HER2-positive breast cancer, RPA RTOG prognostic class, systemic treatment, triple-negative breast cancer, whole-brain radiotherapy (WBRT)

Received for publication June 30, 2009. Accepted for publication July 14, 2009.


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