Breast cancer subtype and intracranial recurrence patterns after brain-directed radiation for brain metastases.

Abstract

PURPOSE:

Brain metastases from breast cancer are frequently managed with brain-directed radiation but the impact of subtype on intracranial recurrence patterns after radiation has not been well-described. We investigated intracranial recurrence patterns of brain metastases from breast cancer after brain-directed radiation to facilitate subtype-specific management paradigms.

METHODS:

We retrospectively analyzed 349 patients with newly diagnosed brain metastases from breast cancer treated with brain-directed radiation at Brigham and Women's Hospital/Dana-Farber Cancer Institute between 2000 and 2015. Patients were stratified by subtype: hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-), HER2+ positive (HER2+), or triple-negative breast cancer (TNBC). A per-metastasis assessment was conducted. Time-to-event analyses were conducted using multivariable Cox regression.

RESULTS:

Of the 349 patients, 116 had HR+/HER2- subtype, 164 had HER2+ subtype, and 69 harbored TNBC. Relative to HR+/HER2- subtype, local recurrence was greater in HER2+ metastases (HR 3.20, 95% CI 1.78-5.75, p < 0.001), while patients with TNBC demonstrated higher rates of new brain metastases after initial treatment (HR 3.16, 95% CI 1.99-5.02, p < 0.001) and shorter time to salvage whole brain radiation (WBRT) (HR 3.79, 95% CI 1.36-10.56, p = 0.01) and salvage stereotactic radiation (HR 1.86, 95% CI 1.11-3.10, p = 0.02).

CONCLUSIONS:

We identified a strong association between breast cancer subtype and intracranial recurrence patterns after brain-directed radiation, particularly local progression for HER2+ and distant progression for TNBC patients. If validated, the poorer local control in HER2+ brain metastases may support evaluation of novel local therapy-based approaches, while the increased distant recurrence in TNBC suggests the need for improved systemic therapy and earlier utilization of WBRT.

• Authors: Daniel N Cagney, Nayan Lamba, Sofia Montoya, Puyao Li, Luke Besse, Allison M Martin, Rachel H Brigell, Paul J Catalano, Paul D Brown, Jose P Leone, Shyam K Tanguturi, Daphne A Haas-Kogan, Brian M Alexander, Nancy U Lin, Ayal A Aizer
• Journal: Breast cancer research and treatment (Breast Cancer Res Treat) Vol. 176 Issue 1 Pg. 171-179 (Jul 2019) ISSN: 1573-7217 [Electronic] Netherlands
• PMID: 30982195 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor

Topics

• Adult
• Aged
• Biomarkers, Tumor
• Biopsy
• Brain Neoplasms (diagnosis, radiotherapy, secondary)
• Breast Neoplasms (diagnosis, pathology)
• Cause of Death
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Treatment Outcome