Improved survival of breast cancer patients with cerebral metastasis treated with stereotactic radiosurgery (SRS)

Clark C Chen1, Kenneth Ott1, Bob Carter1, David Hodgen1, Steve Goetsch1


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

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     Advances in therapeutic and patient care have improved the survival of many subgroups of cancer patients. 
     However, whether such trends apply to the patients with cerebral metastasis treated with stereotactic radiosurgery (SRS) remain unclear. We sought to evaluate outcomes in brain metastases patients with different cancer types.
     1023 patients records were studied.
     To address this question, we retrospectively analyzed the overall survival of 1023 patients treated at the San Diego Gamma Knife Center from 1994 to 2011. This time span was divided into three periods: 1994-1999, 2000-2005, and 2006-2011. Kaplan Meier (KM) survival of treated patients during these periods were stratified by pathology and compared.
     For the breast cancer patients, the overall survival sequentially improved over the three periods (p=0.047). The survival gain was most evident in patients age <65 and KPS >70. While a trend toward improvement was noted for melanoma patients, the association did not reach statistical significance (p= 0.10). Colon cancer patients harbor the worst prognosis and presented with the largest lesions (p <0.01).
     This was a retrospective review.
     For patients afflicted with cerebral metastasis treated with SRS, survival gain in patient survival has been made over the past fifteen years – particularly in patients age<65 and KPS>70. This sub-population of patient warrant particular consideration for focal radiation therapy given the known long-term neuro-toxicity associated with whole brain radiation therapy. 
     The larger cerebral metastasis observed in treated colon cancer patients suggest delay in diagnosis as a potential contributor to the poor clinical outcome.


Project Roles:

C. Chen (), K. Ott (), B. Carter (), D. Hodgen (), S. Goetsch ()