Introduction: Improved survival following the diagnosis of breast cancer, in conjunction with new therapies and diagnostics, has potentially altered the characteristics and course of patients presenting with metastatic breast cancer to the CNS.
Methods: Review of clinical and radiographic records of women presenting to a tertiary medical center with the new diagnosis of CNS metastatic disease from breast cancer. This was a retrospective review from patients identities obtained from two prospective databases.
Results: There were 88 women analyzed who were treated over the period 1/2003-2/2010, with an average age of 56.9 years. At the time of initial presentation of CNS disease, 68% of patients had multiple brain metastases, 17% had a solitary metastasis and 15% had only leptomeningeal disease (LMD). The median survival for all patients from the time of diagnosis of breast disease was 50.0 months, and 9.7 months from diagnosis of CNS involvement. The only factor related to overall survival was estrogen receptor positive (ER+) pathology (57.6 v. 38.2 months, p=.02 log-rank); those related to survival post CNS diagnosis were presentation with LMD (p=.004, HR= 3.1, Cox regression) and triple negative hormonal/HER2 status (p=.02, HR= 2.3, Cox regression). Patients with either had a median survival of 3.1 months. Of the 75 patients who initially presented with metastatic brain lesions, 20 (26%) subsequently developed LMD in the course of their disease (median 10.4 months), following which survival was grim (1.8 months median). Symptoms of LMD were most commonly lower extremity weakness (14/33), followed by cranial nerve deficits (11/33).
Conclusions: In caring for those with metastatic brain disease from breast cancer neurosurgeons should be aware of the patient’s hormonal status (as it markedly effects survival) and be vigilant for the development of LMD, especially as it often presents with non-descript complaints such as back pain.
Patient Care: Understanding the degree to which metastatic breast cancer involves the central nervous sytems and the common presenting symptoms should help raise physician awarness. Knowledge of breast cancer hormone receptor status when metastatic disease occurs can help guide clinician treatment plans and give patients prognosistic information.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the overall prognosis for patients with metastatic breast cancer to the central nervous system, 2) Understand how breast cancer hormonal receptor status impacts patient outcomes, 3) Be aware of the common presenting symptoms of leptomeningeal spread of breast cancer.