Journal article
Incidence of Brain Metastases in Women Treated With Neoadjuvant Chemotherapy for Breast Cancer: Implications for Screening
Clinical breast cancer, Vol.22(8), pp.e916-e921
08/11/2022
DOI: 10.1016/j.clbc.2022.08.002
PMID: 36068116
Abstract
Patients with metastatic breast cancer may develop brain metastases. Our study identified high-risk patients to refine selection criteria for BM screening approaches.
We reviewed breast cancer patients treated with neoadjuvant chemotherapy (NAC) at a single university center between 2005 and 2019.
Competing risks analysis was performed with the Fine and Gray model to analyze the cumulative incidence of BM and loco-regional recurrence. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier and log-rank tests. Multivariable analysis was performed with Cox proportional hazards regression to identify factors predictive for development of BM. Statistical significance was determined as a 2-sided P value of <.05.
In total, 112 patients experienced distant failure (DF) and 49 patients developed BM. Twenty patients with BM (41%) presented with symptoms requiring craniotomy +/- whole brain radiation treatment. Patients with BM were significantly more likely to have local (P < .01) and regional (P < .01) failure. On multivariable analysis, age <40 years (P = .011), presence of lung metastases (P < .0001), and residual nodal disease with >4 lymph nodes positive after NAC (P = .024) all predicted for increased likelihood of BM. Patients with these criteria had higher likelihoods of having BM (P = .013) and worse PFS (P = .044). On multivariable analysis for OS, presence of lung metastases was the most significant predictor of poor outcome (P < .0001).
We propose a study of screening brain MRI for young (<40 years) patients with breast cancer receiving NAC and patients who develop metastatic disease post-NAC, especially those with lung involvement.
Early detection of brain metastases (BM) may prevent patients from undergoing invasive and morbid treatments. Outcomes of 485 patients with breast cancer were analyzed to inform brain MRI screening for high-risk patients. Patients with breast cancer under age 40 and with lung metastases were found to have increased likelihood of BM and may benefit from screening.
Details
- Title: Subtitle
- Incidence of Brain Metastases in Women Treated With Neoadjuvant Chemotherapy for Breast Cancer: Implications for Screening
- Creators
- Margaret M Kozak - University of IowaJamie Karl - Stanford UniversityRie von Eyben - Stanford UniversityFelicia Guo - Stanford UniversityPaulina Gutkin - Stanford UniversityKathleen Horst - Stanford University
- Resource Type
- Journal article
- Publication Details
- Clinical breast cancer, Vol.22(8), pp.e916-e921
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.clbc.2022.08.002
- PMID
- 36068116
- ISSN
- 1526-8209
- eISSN
- 1938-0666
- Language
- English
- Date published
- 08/11/2022
- Academic Unit
- Radiation Oncology
- Record Identifier
- 9984312967702771
Metrics
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