In cohort studies, estimated incidence of breast cancer (BC) brain metastases (BM) is about 5%. This number seems to be increasing, due to longer survival. We intend to characterize the population of breast cancer patients treated in a single institution who developed BM in a 10-year-period.
Retrospective descriptive study revising clinical charts of BC patients with BM, diagnosed between January 2008 - January 2018. Data on patient and tumour characteristics, treatments and outcomes were analysed using IBM SPPS statistics.
From 217 patients with metastatic BC in our institution, 21 developed BM (9,7%), all females. Median age at diagnosis was 45 years (28-66), the majority were de novostage IV (38,1%) patients. Only one patient presented BM at diagnosis. The most frequent molecular subtype was Luminal B (38,1%), followed by HER2 + (33,3%). Median time to BM were 30 months (0-143). Time to BM was not associated with molecular subtype (pearson χ2 = 63, p = 0,37) nor with age at diagnosis (pearson χ2 = 357, p = 0,252). Eleven patients had a single lesion at presentation, of whom 5 were submitted to surgery and 1 to stereotaxic radiotherapy. Nine patients had multiple lesions at CNS presentation. Sixteen patients received whole-brain radiotherapy. Two patients had meningeous carcinomatosis (MC) as exclusive CNS manifestation, while other 3 patients developed MC after previously diagnosed BM. Four patients received intrathecal therapy: 1 with methotrexate (Her 2 -) and 3 with trastuzumab (Her 2 +). Median survival after MC was 1,4 months. From the 21 patients with BM, 12 (57%) died within a median of 8,5 months (0-50). Nine patients are still alive with a median follow-up time since BM of 28 months (9-156).
Within a 10-year period, we found a prevalence of BM of 9,7% in our institution, which is higher than published data. Noteworthy, 9 patients are still alive after BM management. As expected, MC was rare (5 patients), and prognosis was poor. The 4 patients treated with intrathecal therapy seem to have had limited benefit. In conclusion, BM are a relevant problem in BC with low survival and more effective treatments are needed.
Marta Vaz Batista.
Has not received any funding.
All authors have declared no conflicts of interest.