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Novel prognostic classification predicts overall survival of patients receiving salvage whole-brain radiotherapy for recurrent brain metastasis from breast cancer: A recursive partitioning analysis (KROG 16-12)

 Jae Sik Kim  ;  Kyubo Kim  ;  Wonguen Jung  ;  Kyung Hwan Shin  ;  Seock-Ah Im  ;  Yong Bae Kim  ;  Jee Suk Chang  ;  Doo Ho Choi  ;  Haeyoung Kim  ;  Yeon Hee Park  ;  Dae Yong Kim  ;  Tae Hyun Kim  ;  Jeanny Kwon  ;  Ki Mun Kang  ;  Woong-Ki Chung  ;  Kyung Su Kim  ;  In Ah Kim 
 BREAST, Vol.60 : 272-278, 2021-12 
Journal Title
Issue Date
Brain ; Brain Neoplasms* / radiotherapy ; Brain Neoplasms* / surgery ; Breast Neoplasms* / radiotherapy ; Cranial Irradiation ; Female ; Humans ; Neoplasm Recurrence, Local / radiotherapy ; Prognosis ; Radiosurgery* ; Retrospective Studies ; Treatment Outcome
Brain metastasis ; Breast cancer ; Overall survival ; Recursive partitioning analysis ; Whole-brain radiotherapy
Background: To investigate outcomes of salvage whole-brain radiotherapy (WBRT) for recurrent brain metastases (BM) from breast cancer (BC), to identify prognostic factors of overall survival (OS), and to propose a novel prognostic classification for OS in these patients.

Materials and methods: We identified 54 patients who had received salvage WBRT as the second brain-focused treatment for recurrent BM from BC (2000-2014). The median follow-up duration was 4.9 months. A recursive partitioning analysis (RPA) was conducted to develop a model to predict OS at the time of salvage WBRT.

Results: The median OS was 6.8 months. OS according to BC-specific graded prognostic assessment (breast-GPA), modified breast-GPA, and updated breast-GPA did not represent our cohort. In the multivariate analysis, a long time before salvage WBRT (≥16 months), control of primary BC or extracranial metastases, systemic treatment after salvage WBRT, and administration of a biologically effective dose for an α/β of 10 Gy (BED10) of salvage WBRT >37.5 Gy showed superior OS. We proposed three RPA classes based on the control of both primary BC and extracranial metastasis and BED10 of salvage WBRT: class I, class II, and class III. In this model, patients with class I experienced the best OS (34.6 months; class II, 5.0 months; class III, 2.4 months; P < 0.001).

Conclusions: In our RPA classification according to the control of both primary BC and extracranial metastasis and the dose of salvage WBRT, significant differences in OS were observed. The subsequent use of a systemic treatment showed better OS.
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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
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