Table 6.
Selected studies of brain SRS in patients with brain metastases from a breast primar.
| Study | No patients/no lesions/dose | Survival | Local and intra-cranial control | Observations |
|---|---|---|---|---|
| Shenker et al. (14) | 128 pts 1-2BM/pt 20Gy/fx (10-24Gy) |
- medOS-16.3 mts OS-1y = 56% OS-2y = 18% OS-2y = 10% |
- IC failure−6 m = 24% - IC failure−12 m = 41% - IC failure−24 m = 51% |
- ER,PR ± trend toward decreased neurological death - Factors associated with non-neurological death: status extracranial disease, dose, Her 2 status |
| Wolf et al. (15) | 200 pts 1237 BM (diff histology) Med 18Gy/fx |
LC1y = 97% LC2y = 93% LC = 100% for TS < 1 cm |
Increased survival for lesions < 1 cm | |
| Pessina et al. (16) | 66 pts Surgery–SRS/WBRT |
Med OS = 30.7 mts OS-1y = 78.5% OS-2y = 57.4% OS-3y = 43.3% |
LRR-24.2% LC-1y = 87.5% LC-2y = 71.2% LC-3y = 63% |
- Factors associated with survival: KPS, number of BM, local treatment performed, status of EC disease at the time of dg of BM, treat with Herceptine |
| Mix et al. (17) | 214 pts 23% GK SRS 46% SRS-WBRT 31% WBRT |
Med OS21 mts SRS vs. 3 mts WBRT | NR | - WBRT prior or as salvage did not impact survival - Tumor volume and Her 2 status significantly associated with OS - ER status did not impact on OS |
| Roehrig et al. (18) | 111 pts | Med OS = 16.8mts OS-1y = 59.5% OS-2y = 38.4% |
NR | KPS – strongest predictor for survival in MVANo impact of number lesions, WBRT |
| Mohammadi et al. (19) | 896 pts- 3034BM (< 2 cm in size) 166 breast cancer |
Med OS = 14.9 mts | - New IC lesions rate-45% after a median of 10.2 mts - 10% rate of local progression | - Factors associated with local/IC control: tumor diameter (< or >1cm), tumor volume, conformality index, prescribed dose (24Gy vs. < 24) |
| Nieder et al. (20) | 25 pts brain -only mets WBRT+/-SRS | MedOS−11.7 mts OS-1y = 48% OS- 2y = 28% |
Brain PFS - Med = 6.2 mts - @1y = 22% Med time to brain progression−10.8mts Freedom of brain progression @1y−36% |
- Predictors for OS: KPS, TNBC, coordination deficits, lack of upfront surgery, lack of hormone therapy/herceptine - Predictors for brain PFS: KPS, location (cerebellar worse), cognitive or coordination deficits, systemic treatments after SRS |
| Cho et al. (21) | 131 pts Med−3 lesions/pt (1-22) | - Med time SRS to death = 15.7 mts - Med OS = 7 mts for TNBC | - ER+Her2- and Her 2 + - longest survival - TNBC poor prognostic - Prior WBRT, age – no impact - Cerebellar lesions TNBC – worse survival |
|
| Yang et al. (22) | 136 pts 186 BM |
Med Sv- 17.6 mts OS-1y = 65% OS-2y = 45% |
LF-1y = 10% Regional failure @12mts = 45% |
- In MVA – predictors for Sv: >1lesion, TNBC, active EC disease - EC disease associated with regional failure - Tumor size – associated with risk of LF |
| Tam et al. (23) | 57pts 28pts Her2+ |
Her 2+ vs. Her 2- Med OS = 22 vs. 12 mts |
Her2+ vs. Her 2- - medTTP- 7 vs. 11mts - Salvage tt: 50% vs. 21% | - Her 2+ appears to show higher rates of intra-cranial relapse, despite better OS rates |
| Yomo et al. (24) | 80 pts 40 pts Her 2+ |
Lapatinib vs. non-lapatinib tt: -OS-1y = 50% vs. -OS−2 y = 26% |
LC−1y = 84% LC−2yc = 70% Lapatinib vs. non-lapatinib LC-1y = 86 vs. 69% |
- Factors associated with survival: Her 2 status, RPA class, total PTV at initial SRS - Factors associated with local control: tumor volume, peripheral dose |
| Xu et al. (25) | 103 pts – 24 with TNBC | TNBC vs. non-TNBC- OS (after dg): 43 vs. 82 mts - Neurological Sv: 13 vs. 25 mts - Radiosurgical Sv: 6 vs. 16 mts |
- TNBC – adverse prognostic factor | |
| Kelly et al. (26) | 79 pts Had salvage SRS>3mts after initial treatment 76 of them - WBRT |
Med OS = 9.8 mts | Brain PFS Median = 5.7 mts post-SRS |
- Her 2+ status and stable EC disease have improved clinical course and survival - 82% of these patients would require further systemic treatment |
| Caballero et al. (27) | 310 pts salvage SRS 90 pts – breast cancer |
Med OS −8.4 mts | Favorable fact for survival in breast cancer patients: single brain met, age < 50, longer time interval WBRT-SRS | |
| Kondziola et al. (10) | 350 pts 1535BM SRS at dg or at recurrence Srs dose -RTOG criteria |
OS 6mts-69% 12mts−49% 24 mts−26% |
- Longer OS if controlled EC disease, lower RPA, higher KPS, smaller number of metastases, smaller tumor volume, deep metastases, Her 2+ | |
| Karam et al. (28) | 441 pts 40% Her 2+ |
Med OS (from brain treat)-4.5 mts Med OS RPA 1vs. 2 vs. 3 = 14.5 vs. 6.4 vs. 1.8 mts |
- RPA class significantly associated with survival |