Novel prognostic classification predicts overall survival of patients receiving salvage whole-brain radiotherapy for recurrent brain metastasis from breast cancer: A recursive partitioning analysis (KROG 16-12)

Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock Ah Im, Yong Bae Kim, Jee Suk Chang, Doo Ho Choi, Haeyoung Kim, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Jeanny Kwon, Ki Mun Kang, Woong Ki Chung, Kyung Su Kim, In Ah Kim

Research output: Contribution to journalArticlepeer-review

Abstract

Background: To investigate outcomes of salvage whole-brain radiotherapy (WBRT) for recurrent brain metastases (BM) from breast cancer (BC), to identify prognostic factors of overall survival (OS), and to propose a novel prognostic classification for OS in these patients. Materials and methods: We identified 54 patients who had received salvage WBRT as the second brain-focused treatment for recurrent BM from BC (2000–2014). The median follow-up duration was 4.9 months. A recursive partitioning analysis (RPA) was conducted to develop a model to predict OS at the time of salvage WBRT. Results: The median OS was 6.8 months. OS according to BC-specific graded prognostic assessment (breast-GPA), modified breast-GPA, and updated breast-GPA did not represent our cohort. In the multivariate analysis, a long time before salvage WBRT (≥16 months), control of primary BC or extracranial metastases, systemic treatment after salvage WBRT, and administration of a biologically effective dose for an α/β of 10 Gy (BED10) of salvage WBRT >37.5 Gy showed superior OS. We proposed three RPA classes based on the control of both primary BC and extracranial metastasis and BED10 of salvage WBRT: class I, class II, and class III. In this model, patients with class I experienced the best OS (34.6 months; class II, 5.0 months; class III, 2.4 months; P < 0.001). Conclusions: In our RPA classification according to the control of both primary BC and extracranial metastasis and the dose of salvage WBRT, significant differences in OS were observed. The subsequent use of a systemic treatment showed better OS.

Original languageEnglish
Pages (from-to)272-278
Number of pages7
JournalBreast
Volume60
DOIs
StatePublished - Dec 2021

Keywords

  • Brain metastasis
  • Breast cancer
  • Overall survival
  • Recursive partitioning analysis
  • Whole-brain radiotherapy

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