Population-based Analysis of Treatment and Survival in Women Presenting With Brain Metastasis at Initial Breast Cancer Diagnosis

Perspectives on the Systemic Staging in Newly Diagnosed Breast Cancer

Breast cancer is a complex disease, and accurate systemic staging is an essential aspect of the evaluation of a patient with newly diagnosed breast cancer. Considering that the chance of having metastatic disease at breast cancer diagnosis is different in each patient and depends on a variety of anatomic and biologic factors, it is crucial to understand that some populations may benefit from more intensive staging because their pretest probability of metastatic disease is higher than that of the average patient. Identifying these patients with de novo stage IV breast cancer is associated with substantial prognostic and therapeutic implications. Unfortunately, recent advances in understanding breast cancer heterogeneity and molecular biology have not been incorporated in the international guidelines and recommendations about imaging examinations for detecting de novo metastatic breast cancer. This review article discusses important issues regarding the rationale for performing systemic staging, addresses current and innovative imaging methods, and proposes an algorithm for systemic staging in patients with newly diagnosed breast cancer.

Distribution of metastasis in the brain in relation to the hippocampus: a retrospective single-center analysis of 565 metastases in 116 patients

OBJECTIVE

To examine the distribution of brain metastases (BM) in relation to the hippocampus, so as to determine the risk of metastasis in the hippocampus, and thus provide experimental evidence for the hippocampal avoidance (HA) in patients with BM during radiotherapy.

METHODS

(1) For the retrospective analysis of 116 patients diagnosed with malignancies, confirmed as BM, from December 2014 to December 2016 at the First Affiliated Hospital of Bengbu Medical College. We obtained the T1-weighted, postcontrast axial, sagittal, and coronal Magnetic Resonance imaging (MRI) images f the patients, in supine position, using the head restraints and head thermoplastic masks to adjust the positioning, with computed tomography (CT) positioning scan ranging from the head to the mandible (layer thickness: 3 mm). CT and MRI images were fused on a Philips Pinnacle v9.8 treatment planning system;(2) Every metastasis of the 565 metastases was contoured;(3) hippocampus were contoured, and hippocampus with 5 mm expansion envelopes were analyzed;(4) Using the SPSS 16.0 software, we analyzed the relation between the distribution and age, sex, Karnofsky performance status (KPS), primary site, aggregate volume of intracranial metastases and the whole brain. The data were analyzed using a binary logistic regression analysis method, with two-sided P < 0.05 for statistical significance.

RESULTS

In this study, we recruited 116 patients with 565 metastases. Among them, 1.7% (n = 2) had metastases in the hippocampus, and 11.2% (n = 13) had metastases within 5 mm of the hippocampus, of which more than half were patients with non-small cell lung cancer (n = 7). Using a binary logistic regression to analyze the relation between the metastases located within 5 mm of the hippocampus and age (P = 0.395), sex (P = 0.139), KPS (P = 0.724), primary site (P = 0.894), aggregate volume of intracranial metastases (p = 0.093) and the whole brain (p = 0.998), and none of them showed statistically significant difference between them and the metastases location (P>0.05).

CONCLUSION

This study showed a low risk for the perihippocampal metastases (PHM) and no significant correlation between PHM and age, sex, KPS, primary site, aggregate volume of intracranial metastases and the whole brain. Accordingly, it is may be acceptable to avoid the perihippocampal region during whole brain radiotherapy.

Distribution of metastatic disease in the brain in relation to the hippocampus: a retrospective single-center analysis of 6064 metastases in 632 patients

This study aimed to investigate the patterns of brain metastasis and to explore the risk factors affecting hippocampus metastasis (HM). We retrospectively analyzed the clinical information of patients with metastatic disease in the brain. The associations between clinicopathologic variables with HM and peri-hippocampal metastasis (PHM) were evaluated in univariate and multivariate regression analyses. A total of 632 patients with 6064 metastatic lesions were recruited into the present study. Of these, 4.1% (26/632) of patients developed HM, and 5.5% (35/632) of patients developed PHM. Only 0.5% (31/6064) of metastatic lesions were located in the hippocampus and 0.6% (37/6064) were in the PHM. Age ≤60 years was an independent risk factor for HM (odds ratio [OR]: 2.602, 95% confidence interval [CI]: 1.115–6.076, P = 0.027) and PHM (OR: 2.555, 95%CI: 1.229–5.310, P = 0.012) in univariate and multivariate analyses. The hippocampus is a rare site of brain metastasis. Younger patients (age ≤60 years) had increased risk of developing HM and PHM. The current study provides the opportunity to investigate the clinical feasibility of hippocampal sparing whole brain radiation therapy, especially in older patients.

Prognostic factors and survival of patients with brain metastasis from breast cancer who underwent craniotomy

Brain metastasis (BM) in patients with breast cancer is a catastrophic event that results in poor prognosis. Identification of prognostic factors associated with breast cancer brain metastases (BCBM) could help to identify patients at risk. The aim of this study was to assess clinical characteristics, prognostic factors, and survival of patients with BCBM who had craniotomy and resection in a series of patients treated with modern multimodality therapy. We analyzed 42 patients with BCBM who underwent resection. Patients were diagnosed with breast cancer between April 1994 and May 2010. Cox proportional hazards regression was selected to describe factors associated with time to BM, survival from the date of first recurrence, and overall survival (OS). Median age was 51 years (range 24–74). Median follow-up was 4.2 years (range 0.6–18.5). The proportion of the biological subtypes of breast cancer was ER+/HER2− 25%, ER+/HER2+ 15%, ER-/HER2+ 30%, and ER-/HER2− 30%. Median OS from the date of primary diagnosis was 5.74 years. Median survival after diagnosis of BM was 1.33 years. In multivariate Cox regression analyses, stage was the only factor associated with shorter time to the development of BM (P = 0.033), whereas age was the only factor associated with survival from the date of recurrence (P = 0.027) and with OS (P = 0.037). Stage at primary diagnosis correlated with shorter time to the development of BM, while age at diagnosis was associated with shorter survival in BCBM. None of the other clinical factors had influence on survival.