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  • Repeat Radiosurgery for Breast Cancer Patients with Multiple Brain Metastases

    Final Number:

    Alp Ozpinar MD; Jennifer Perez; BaDoi Nguyen BS Phan; Edward A. Monaco MD, PhD; Ajay Niranjan MD MBA; John Flickinger MD; L. Dade Lunsford MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Evidence now supports stereotactic radiosurgery (SRS) as the best method to maintain local control and quality of life (QOL) for patients with brain metastases, reserving WBRT for patients who develop carcinomatous meningitis or miliary brain disease. We investigated neurological outcomes, tumor control, and survival data breast cancer (BC) patients who presented with multiple brain metastases including those who required repeat SRS for additional intracranial metastases.

    Methods: From our data base we identified 231 female patients (age range 29-82 , mean age = 53 years) who underwent multiple SRS procedures during a 30 year interval. We evaluated clinical, imaging, and outcomes before and after SRS performed with one or more versions of the Leksell Gamma Knife. Parameters were analyzed using Kaplan-Meier survival curves, and univariate and multivariate Cox regression.

    Results: 79% of patients were classified as RPA Class II. The median survival after diagnosis of was 19.9 (range 1.5-250) months. The median survival for patients with limited (2-4) and those with > 4 brain metastases was not significantly different. 89 (39%) patients underwent a single additional SRS (SRS-2) treatment, 27 (12%) had two additional SRS treatments (SRS-3), and 21 (9.1%) had three or more additional SRS treatments (SRS-4+). The median survival was 11 months after SRS-2, 24 months after SRS-3, and 13 months after SRS-> 3 times. 15(6.5%) of patients underwent salvage whole brain radiation therapy. The incidence of neurological death was 8%, 20%, 0%, and 12.5% following SRS-1, SRS-2, SRS-3, and SRS> 3 procedures. Although 19 (8%) patients developed symptomatic adverse radiation effects (ARE) related to intracranial-directed therapies, ARE had no significant effect on patient survival.

    Conclusions: Repeat SRS provides brain disease control and improves neurological death in patients with breast cancer spread to the brain.

    Patient Care: Intracranial breast cancer metastasis can be controlled with repeated GKRS with good side effect profile. With the advent of new systemic treatments , our findings will provide improved care for breast cancer patient population.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) understand the role of repeat GKRS for multiple intracranial breast cancer metastasis,2) Discuss the shortcomings of standalone WBRT for multiple intracranial metastasis,3) identify a treatment algorithm for this patient population


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