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). (December 2021)

• Record Type: Journal Article
• Authors: Kim, Jae Sik; Kim, Kyubo; Jung, Wonguen; Shin, Kyung Hwan; Im, Seock-Ah; Kim, Yong Bae; Chang, Jee Suk; Choi, Doo Ho; Kim, Haeyoung; Park, Yeon Hee; Kim, Dae Yong; Kim, Tae Hyun; Kwon, Jeanny; Kang, Ki Mun; Chung, Woong-Ki; Kim, Kyung Su; Kim, In Ah
• Is Part Of: Breast. Volume 60(2021)
• Page Start: 272
• Page End: 278
• Publication Date: 2021-12
• Subjects: Breast cancer -- Brain metastasis -- Whole-brain radiotherapy -- Overall survival -- Recursive partitioning analysis; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2021.11.005
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: 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. Highlights: Multicenter retrospective study of salvage WBRT for recurrent brain metastasis. Subsequent use of systemic treatment after salvage WBRT showing better OS. Limitations of previous graded prognostic assessments for recurrent brain metastasis. Novel RPA classification consisting of four simple clinical factors predicts OS.