Clinical Outcomes of Breast Cancer Brain Metastases Treated with Stereotactic Radiation and Capecitabine

2020 ◽  
Vol 108 (3) ◽  
pp. e685-e686
Author(s):  
M.N. Mills ◽  
A. Naz ◽  
C. Thawani ◽  
C. Walker ◽  
N.B. Figura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Clinical Outcomes ◽  
Stereotactic Radiation ◽  
Breast Cancer Brain Metastases

scholarly journals RADT-02. CLINICAL OUTCOMES OF BREAST BRAIN METASTASES BY SUBTYPE FOLLOWING LINAC BASED STEREOTACTIC RADIATION

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii181-ii182
Author(s):  
Chetna Thawani ◽  
Matthew Mills ◽  
Nicholas Figura ◽  
Siriporn Sarangkasiri ◽  
Iman Washington ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Clinical Outcomes ◽  
Breast Cancer Subtype ◽  
Leptomeningeal Disease ◽  
Breast Cancer Patients ◽  
Stereotactic Radiation ◽  
Failure Patterns ◽  
Cancer Subtype ◽  
Breast Cancer Brain Metastases

Abstract BACKGROUND Management of breast cancer brain metastases has become an increasing concern due to improved systemic control. Failure patterns in the brain may vary by breast cancer subtype. OBJECTIVE In this study, we sought to distinguish our institutional clinical outcomes following stereotactic radiation by breast cancer subtype. METHODS A total of 180 breast cancer patients treated over 279 stereotactic sessions to 646 brain metastases were identified from our LINAC based stereotactic radiation institutional registry. Patients were treated between August 2004 and May 2019. Outcomes including distant brain metastases control (DC) as well as overall survival (OS) following stereotactic radiation were assessed from review of the clinical chart and radiologic examinations. RESULTS The median age of patients was 55 (range: 28-86 years). Subtypes in order of decreasing frequency were hormone receptor (HR)+ (n=64; 36%), HR+/HER2+ (n=47; 26%), triple negative (TN) (n=43; 24%), and HR-/HER2+ (n=26; 14%). TN patients had the shortest interval from systemic metastases to brain metastases diagnosis; HR-/HER2 + 16 months, HR+ 13.3 months, HR+/HER2 + 11 months, and TN 1.4 months (p=0.02). Median follow-up from brain metastases diagnosis was 21.2 months (range: 0.9-135.4 months). Twenty-four month Kaplan-Meier (KM) DC rates varied by subtype and were 49% (HR+/HER2+), 38% (HR+), 33% (HR-/HER2+) and 21% (TN) (p=0.0004), respectively. Similar differences were noted in OS with 24 month KM rates of 58% (HR+/HER2+), 51% (HR-/HER2+), 27% (HR+), and 14% (TN), p< 0.0001. A total of 26 patients (14%) were noted to undergo leptomeningeal disease (LMD) progression. No differences were noted by subtype and LMD progression (p=0.88). CONCLUSIONS In our institutional series of breast cancer brain metastases treated with stereotactic radiation, significant differences were noted in clinical outcomes by breast cancer subtype. HR+/HER2+ patients had the best DC and OS rates while outcomes were poorest for TN patients.

CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases

2019 ◽  
Vol 144 (3) ◽  
pp. 583-589 ◽  
Author(s):  
Nicholas B. Figura ◽  
Thrisha K. Potluri ◽  
Homan Mohammadi ◽  
Daniel E. Oliver ◽  
John A. Arrington ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Hormone Receptor ◽  
Stereotactic Radiation ◽  
Hormone Receptor Positive ◽  
Breast Cancer Brain Metastases ◽  
Positive Breast Cancer

The incidence and predictive factors for leptomeningeal spread after stereotactic radiation for breast cancer brain metastases

2017 ◽  
Vol 24 (3) ◽  
pp. 424-425 ◽  
Author(s):  
Orit Kaidar-Person ◽  
Allison M. Deal ◽  
Carey K. Anders ◽  
Matthew G. Ewend ◽  
Elizabeth C. Dees ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Predictive Factors ◽  
Stereotactic Radiation ◽  
Leptomeningeal Spread ◽  
Breast Cancer Brain Metastases

Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases

2021 ◽  
Author(s):  
Matthew N. Mills ◽  
Chetna Thawani ◽  
Nicholas B. Figura ◽  
Daniel E. Oliver ◽  
Aixa E. Soyano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Clinical Outcomes ◽  
Breast Cancer Subtype ◽  
Stereotactic Radiation ◽  
Cancer Subtype

scholarly journals Capecitabine and stereotactic radiation in the management of breast cancer brain metastases

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew N. Mills ◽  
Afrin Naz ◽  
Chetna Thawani ◽  
Chelsea Walker ◽  
Nicholas B. Figura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Stage Iv ◽  
Median Number ◽  
Stereotactic Radiation ◽  
Kaplan Meier ◽  
Potential Synergy ◽  
Stage Iv Disease ◽  
Breast Cancer Brain Metastases

Abstract Background Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM). Methods Twenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist. Results Median follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR−/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15–24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24–30 Gy) in a median of 5 fractions (range: 3–5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively. Conclusions In our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.

scholarly journals Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 303
Author(s):  
Edy Ippolito ◽  
Sonia Silipigni ◽  
Paolo Matteucci ◽  
Carlo Greco ◽  
Francesco Pantano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Overall Response Rate ◽  
Response Rate ◽  
Growth Factor Receptor ◽  
Single Institution ◽  
Stereotactic Radiation ◽  
Overall Response ◽  
Local Progression ◽  
Breast Cancer Brain Metastases

(1) Background: This study aims to assess the safety and efficacy of fractionated SRT (fSRT) and pertuzumab–trastuzumab (PT) in patients with breast cancer brain metastases (BCBM). (2) Methods: Patients with HER2+ BCBM who received FSRT from 2015 to 2019 were identified. Patients were included if they were treated with fSRT within 21 days of receiving PT. All lesions were treated with LINAC-based fSRT to a total dose of 27 Gy delivered in three consecutive fractions. All patients received concurrent PT. Patients were evaluated 4–6 weeks after SRS and subsequently every 2–3 months with MRI re-imaging (3) Results: A total of 49 patients with HER2+ brain metastases were identified. Of these patients, a total of 10 patients with 32 HER2+ BCBM were treated with concurrent SRT and PT and included in the analysis. No local progression was observed. Overall response rate was 68.7%. Only one patient developed asymptomatic radionecrosis. Median time to BM occurrence was 15.6 (range: 1–40.5 months). Distant intracranial failure occurred in 4/10 patients (40.0%). Overall BCBM median survival was 33.9 months (95%CI 24.1–43.6). Mean duration of PT treatment was 27.9 months (range: 10.1–53.7 months). (4) Conclusions: In our single institution experience, fSRT and PT showed to be a safe treatment for patients with BCBM with an adequate overall response rate.

scholarly journals Trastuzumab Emtansine (T-DM1) and stereotactic radiation in the management of HER2+ breast cancer brain metastases

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew N. Mills ◽  
Chelsea Walker ◽  
Chetna Thawani ◽  
Afrin Naz ◽  
Nicholas B. Figura ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Trastuzumab Emtansine ◽  
Median Dose ◽  
Her2 Positive ◽  
Stereotactic Radiation ◽  
Her2 Positive Breast Cancer ◽  
Breast Cancer Brain Metastases ◽  
Positive Breast Cancer

Abstract Background Due to recent concerns about the toxicity of trastuzumab emtansine (T-DM1) with stereotactic radiation, we assessed our institutional outcomes treating HER2-positive breast cancer brain metastases (BCBM) with T-DM1 and stereotactic radiation. Methods This is a single institution series of 16 patients with HER2-positive breast cancer who underwent 18 stereotactic sessions to 40 BCBM from 2013 to 2019 with T-DM1 delivered within 6 months. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), distant intracranial control (DIC), and systemic progression-free survival (sPFS) from the date of SRS. A neuro-radiologist independently reviewed follow-up imaging. Results One patient had invasive lobular carcinoma, and 15 patients had invasive ductal carcinoma. All cases were HER2-positive, while 10 were hormone receptor (HR) positive. Twenty-four lesions were treated with stereotactic radiosurgery (SRS) to a median dose of 21 Gy (14–24 Gy). Sixteen lesions were treated with fractionated stereotactic radiation (FSRT) with a median dose of 25 Gy (20-30Gy) delivered in 3 to 5 fractions. Stereotactic radiation was delivered concurrently with T-DM1 in 19 lesions (48%). Median follow up time was 13.2 months from stereotactic radiation. The 1-year LC, DIC, sPFS, and OS were 75, 50, 30, and 67%, respectively. There was 1 case of leptomeningeal progression and 1 case (3%) of symptomatic radionecrosis. Conclusions We demonstrate that stereotactic radiation and T-DM1 is well-tolerated and effective for patients with HER2-positive BCBM. An increased risk for symptomatic radiation necrosis was not noted in our series.

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