Outcomes and prognostic factors in women with 1 to 3 breast cancer brain metastases treated with definitive stereotactic radiosurgery

Background: With the continuing increase in the use of definitive stereotactic radiosurgery(SRS) for patients with limited brain metastases (BM), clinicians need morespecific prognostic tools. We investigated clinical predictors of outcomes in patientswith limited breast cancer BM treated with SRS alone.

Methods and Materials: We identified 136 patients with breast cancer and 1-3 BMwho underwent definitive SRS for 186 BM between 2000 and 2012. The Kaplan-Meier method was used to assess overall survival (OS), regional failure (RF), and localfailure (LF). Associations between clinical factors and outcomes were tested usingCox regression. A point scoring system was used to stratify patients based on OS,and the predictive power was tested with concordance probability estimate (CPE).

Results: The median OS was 17.6 months. The 12-month RF and LF rates were 45%and 10%, respectively. On multivariate analysis, >1 lesion (hazard ratio [HR] = 1.6,P=.02), triple-negative (TN) disease (HR=2.0, P=.006), and active extracranialdisease (ED) (HR=2.7, P<.0001) were significantly associated with worse OS. Thepoint score system was defined using proportional simplification of the multivariateCox proportional hazards regression function. The median OS for patients with3.0-4.0 points (n=37), 4.5-5.5 points (n=28), 6.0-6.5 points (n=37), and 8-8.5 points(n=34) were 9.2, 15.6, 25.1, and 45.1 months, respectively (P<.0001, CPE = 0.72).Active ED (HR=2.4, PZ.0007) was significantly associated with RF. Higher risk forLF was significantly associated with larger BM size (HR=3.1, P=.0001).

Conclusion: Patients with >1 BM, active ED, and TN had the highest risk of deathafter SRS. Active ED is an important prognostic factor for OS and intracranial control.