The effectiveness of chemotherapy in breast cancer patients with brain metastases

Abstract

Purpose: Treatments of brain metastases in breast cancer include whole brain radiotherapy, surgery, stereotactic radiosurgery, and systemic chemotherapy. The aim of this study was to investigate the clinicopathological factors which were associated with brain metastases-related survival, and to evaluate the efficacy of systemic chemotherapy. Methods: A total of 106 breast cancer patients with brain metastases who were treated at the Seoul St. Mary’s Hospital were retrospectively analyzed. The brain metastases-free survival (BMFS) was defined as the time from first systemic metastases to detection of the brain metastases. Overall survival after brain metastases (OS) was measured from the detection of the brain metastases to death. The patient’s clinicopathological factors which were associated with BMFS and OS and role of systemic chemotherapy on brain metastases were evaluated. Results: The median BMFS was 30.7 months. In univariate analyses, age >50 years, stages I/II, tumor size <5 cm, positive lymph node ≤3, no vascular invasion, positive estrogen receptor, use of adjuvant chemotherapy, solitary brain lesion, and brain metastases as an initial recurrence site were associated with longer BMFS. The median OS after brain metastases was 5.0 months. In univariate analyses, nuclear grade I/II, mitotic activity indices <10, non-triple negative receptor, solitary brain lesion, and administration of local and systemic treatment on brain metastases were associated with longer OS. In multivariate analyses, systemic chemotherapy after brain metastases was the only significant prognostic factor associated with better OS and was effective regardless of blood-brain barrier (BBB) permeability. Conclusion: A systemic chemotherapy after brain metastases improved OS regardless of BBB permeability in breast cancer patients.

Keywords

• breast neoplasm
• metastases
• chemotherapy
• blood-brain barriers