Impact of breast cancer subtype on clinical outcomes after Gamma Knife radiosurgery for brain metastases from breast cancer: a multi-institutional retrospective study (JLGK1702)

Kyoko Aoyagi, Yoshinori Higuchi, Shigeo Matsunaga, Toru Serizawa, Shoji Yomo, Hitoshi Aiyama, Osamu Nagano, Takeshi Kondoh, Hiroyuki Kenai, Takashi Shuto, Jun Kawagishi, Hidefumi Jokura, Sonomi Sato, Kiyoshi Nakazaki, Kotaro Nakaya, Toshinori Hasegawa, Mariko Kawashima, Hideya Kawai, Kazuhiro Yamanaka, Yasushi NagatomoMasaaki Yamamoto, Yasunori Sato, Tomoyoshi Aoyagi, Tomoo Matsutani, Yasuo Iwadate

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Introduction: Brain metastasis (BM) is one of the most important issues in the management of breast cancer (BC), since BMs are associated with neurological deficits. However, the importance of BC subtypes remains unclear for BM treated with Gamma Knife radiosurgery (GKS). Thus, we conducted a multicenter retrospective study to compare clinical outcomes based on BC subtypes, with the aim of developing an optimal treatment strategy. Methods: We studied 439 patients with breast cancer and 1–10 BM from 16 GKS facilities in Japan. Overall survival (OS) was analyzed by the Kaplan–Meier method, and cumulative incidences of systemic death (SD), neurologic death (ND), and tumor progression were estimated by competing risk analysis. Results: OS differed among subtypes. The median OS time (months) after GKS was 10.4 in triple-negative (TN), 13.7 in Luminal, 31.4 in HER2, and 35.8 in Luminal-HER2 subtype BC (p < 0.0001). On multivariate analysis, poor control of the primary disease (hazard ratio [HR] = 1.84, p < 0.0001), active extracranial disease (HR = 2.76, p < 0.0001), neurological symptoms (HR 1.44, p = 0.01), and HER2 negativity (HR = 2.66, p < 0.0001) were significantly associated with worse OS. HER2 positivity was an independent risk factor for local recurrence (p = 0.03) but associated with lower rates of ND (p = 0.03). TN histology was associated with higher rates of distant brain failure (p = 0.03). Conclusions: HER2 positivity is related to the longer OS after SRS; however, we should pay attention to preventing recurrence in Luminal-HER2 patients. Also, TN patients require meticulous follow-up observation to detect distant metastases and/or LMD.

Original languageEnglish
Pages (from-to)149-159
Number of pages11
JournalBreast Cancer Research and Treatment
Volume184
Issue number1
DOIs
Publication statusPublished - 2020 Nov 1

Keywords

  • Brain metastases
  • Breast cancer subtype
  • Competing risk analysis
  • Gamma knife radiosurgery
  • Multi-institutional cooperative study

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Impact of breast cancer subtype on clinical outcomes after Gamma Knife radiosurgery for brain metastases from breast cancer: a multi-institutional retrospective study (JLGK1702)'. Together they form a unique fingerprint.

Cite this