Sperduto Paul, W.,Kased, Norbert.,Roberge, David.,Xu, Zhiyuan.,Shanley, Ryan.,Luo, Xianghua., et al: Effect of Tumor Subtype on Survival and the Graded Prognostic Assessment for Patients With Breast Cancer and Brain Metastases.. International journal of radiation oncology, biology, physics : - , 2011

Douglas Kondziolka, MD, MSc1

1Department of Neurological Surgery, University of Pittsburgh

Keywords: radiotherapy, radiosurgery, breast cancer, gamma knife, brain metastasis

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Commentary

     The authors sought to evaluate factors predicting survival in patients with breast cancer brain metastases.  Numerous predictive methods have been used in the past including the Recursive Partitioning Analysis (RPA) and the Graded Prognostic Assessement (GPA).2 They sought to test the GPA using information on specific types of breast cancer.
     They used multicenter data from 400 patients.
     They included data on all 400 patients without exclusion criteria. The number of tumors was coded as 1,2,3,4,5, or >5. Extracranial metastases was coded as present or absent but the extent was not mentioned- this is a limitation.
     They found that Karnofsky score, hormone receptor status (HER 2, ER/PR status, triple negative) were relevant for survival.  Median survival, based on least favorable or most favorable groups, was 3.4 or 25.3 months respectively. There are clear survival differences associated with different breast cancer subtypes. Whereas earlier studies did not include hormonal status, more and more studies show the effect of hormone status on outcome.1,3
     Hormone status is so crucial as to be mentioned in any discussion of the care of an individual breast cancer patient. At the present time, all studies should include this information so that readers can best understand clinical outcomes.  This article did not address the quality of survival nor patient function.
     The authors provide data on a wide array of treatment approaches. 33% had whole brain radiation therapy alone and 29% had radiosurgery alone. 22% had both. Surgical resection was performed in 17%.  This study does not make recommendations for optimal therapy.  Given the reduced use of whole brain radiation therapy in recent years and the increasing use of radiosurgery, future studies need to address the roles of each approach.


Acknowledgements

Project Roles:

D. Kondziolka (Performed Research)

Disclosure:

D. Kondziolka (Consultant, Elekta)


References

1. Firlik, KS.,Kondziolka, D.,Flickinger, JC.,Lunsford, LD., Stereotactic radiosurgery for brain metastases from breast cancer. Ann Surg Oncol 7: 333 - 338, 2000
2. Gaspar, L.,Scott, C.,Rotman, M., et al: Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37: 745 - 751, 1997
3. Kondziolka, D.,Kano, H.,Harrison, G.,Yang, HC.,Liew, D.,Niranjan, A., et al: Stereotactic radiosurgery as primary or salvage treatment for brain metastases from breast cancer.. J Neurosurg 114: 792 - 800, 2011