Alessia Di Donato1, Aurelia Iurato1, Edy Ippolito1, Francesco Pantano2, Paolo Matteucci1, Michele Fiore1, Giuseppe Tonini2, Sara Ramella1
1Campus Bio-Medico di Roma, Radioterapia Oncologica, Roma, Italy; 2Campus Bio-Medico di Roma, Oncologia Medica, Roma, Italy
Brain metastases (BM) may affect up to 30 % of patients with advanced breast cancer. The incidence is rising with more effective systemic agents and brain recurrence may develop despite stable extracranial disease. The aim of this study was to evaluate the impact of sequential repeated courses of radiotherapy (RT) in breast cancer patients with oligoprogressive isolated BM.
A cohort of consecutive patients with breast BM treated with stereotactic fractionated RT (SFR) were retrospectively identified from institutional databases. Patients with isolated recurrent BM after a first course of RT (either WBRT or SFR) were identified. Brain progression-free survival (BPFS) and Overall Survival (OS) rates from the diagnosis of BM were calculated from the date of first radiotherapy treatment using the Kaplan-Meier method.
68 patients with 161 BM treated with SFR were included in this analysis. Median age was 62 years (35-86). 7% of this population was Luminal A, 37% was Luminal B, 30 % HER2 positive, 10% triple negative and 16% not determined. Thirty patients (44.1%) received more than one radiotherapy course. Eighteen patients (26.5%) received SFR after whole-brain radiotherapy (WBRT). Twelve patients (17.6%) received more than one SFR course (5 patients 2 courses, 6 patients 3 courses and 1 patient 4 courses) for a total of 25 new BM treated. Median dose of repeated SFR was 27 Gy (range 12-45). Median BPFS after first course of RT was 7.9 months (IC 95% 10-41 months) and 7.6 months (IC 95% 1-15 months) after 2 courses. For the entire cohort of patients 1-2 year OS from the diagnosis of BM was 82.1% and 72.8% respectively. For patients who received more than one course of RT the 1-2 year OS was 85.7% and 76.2% (p=NS).
Patients affected by breast cancer BM may experience long survival rates, mainly due to extracranial disease control achieved with new drugs. Therefore more than one course of RT may be needed in these patients presenting with oligoprogressive brain disease. Repeated courses of SFR represent a reasonable and feasible treatment option.