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New brain metastases after whole-brain radiotherapy of initial brain metastases in breast cancer patients: the significance of molecular subtypes (KROG 16-12)

Authors
 Jae Sik Kim  ;  Kyubo Kim  ;  Wonguen Jung  ;  Kyung Hwan Shin  ;  Seock-Ah Im  ;  Hee-Jun Kim  ;  Yong Bae Kim  ;  Jee Suk Chang  ;  Jee Hyun Kim  ;  Doo Ho Choi  ;  Yeon Hee Park  ;  Dae Yong Kim  ;  Tae Hyun Kim  ;  Byung Ock Choi  ;  Sea-Won Lee  ;  Suzy Kim  ;  Jeanny Kwon  ;  Ki Mun Kang  ;  Woong-Ki Chung  ;  Kyung Su Kim  ;  Won Sup Yoon  ;  Jin Hee Kim  ;  Jihye Cha  ;  Yoon Kyeong Oh  ;  In Ah Kim 
Citation
 BREAST CANCER RESEARCH AND TREATMENT, Vol.186(2) : 453-462, 2021-04 
Journal Title
BREAST CANCER RESEARCH AND TREATMENT
ISSN
 0167-6806 
Issue Date
2021-04
MeSH
Brain / metabolism ; Brain Neoplasms* / radiotherapy ; Breast Neoplasms* / radiotherapy ; Female ; Humans ; Prognosis ; Receptor, ErbB-2 / genetics ; Receptor, ErbB-2 / metabolism ; Retrospective Studies ; Triple Negative Breast Neoplasms* / radiotherapy
Keywords
Brain metastasis ; Brain-directed treatment ; Breast cancer ; Tumor molecular subtype ; Whole-brain radiotherapy
Abstract
Purpose: To identify the risk factors leading to new brain metastases (BM) following brain-directed treatment for initial BM resulting from breast cancer (BC).

Methods: In this multi-institutional study, 538 BC patients with available follow-up imaging after brain-directed treatment for initial BM were analyzed. Tumor molecular subtypes were classified as follows: hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-, n = 136), HER2-positive (HER2+, n = 253), or triple-negative BC (TNBC, n = 149).

Results: In 37.4% of patients, new BM emerged at a median of 10.5 months after brain-directed treatment for initial BM. The 1-year actuarial rate of new BM for HR+/HER2-, HER2+, and TNBC were 51.9%, 44.0%, and 69.6%, respectively (p = 0.008). Initial whole-brain radiotherapy (WBRT) reduced new BM rates (22.5% reduction at 1 year, p < 0.001) according to molecular subtype (HR+/HER2-, 42% reduction at 1 year, p < 0.001; HER2+, 18.5%, p = 0.004; TNBC, 16.9%, p = 0.071). Multivariate analysis revealed an increased risk of new BM for the following factors: shorter intervals between primary BC diagnoses and BM (p = 0.031); TNBC (relative to HR+/HER2-) (p = 0.016); presence of extracranial metastases (p = 0.019); number of BM (>4) (p < 0.001); and BM in both tentorial regions (p = 0.045). Anti-HER2 therapy in HER2+ patients (p = 0.013) and initial use of WBRT (p < 0.001) significantly lowered new BM development.

Conclusions: Tumor molecular subtypes were associated with both rates of new BM development and the effectiveness of initial WBRT. Anti-HER2 therapy in HER2+ patients significantly lowered new BM occurrence.
Full Text
https://link.springer.com/article/10.1007%2Fs10549-020-06043-0
DOI
10.1007/s10549-020-06043-0
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187067
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