Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer
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Bing Sun1, Zhou Huang1, Shikai Wu1, Lijuan Ding1, Ge Shen1, Lei Cha2, Junliang Wang1, Santai Song3
1Department of Radiotherapy, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China
2Department of Science and Technology, Academy of Military Medical Sciences, Beijing 100071, China
3Department of Breast Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, China
Shikai Wu, email: [email protected]
Keywords: breast cancer, brain metastases, cyst, whole-brain radiotherapy, stereotactic radiosurgery
Received: July 02, 2016 Accepted: September 05, 2016 Published: September 21, 2016
Purpose: Brain metastasis (BM) with a cystic component from breast cancer is rare and largely uncharacterized. The purpose of this study was to identify the characteristics of cystic BM in a large cohort of breast cancer patients.
Results: A total of 35 eligible patients with cystic BM and 255 patients with solid BM were analyzed. Three factors were significantly associated with an increased probability of developing cystic lesions: age at diagnosis ≤ 40 years, age at BM ≤ 45 years, and poor histological grade (p < 0.05). Patients with cystic metastasis were also characterized by a larger metastasis volume, a shorter progression-free survival (PFS) following their first treatment for BM, and poor overall survival after BM (p < 0.05). Multivariate analysis further demonstrated that local control of cystic BM was only potentially achieved for HER2-negative primary tumors (p = 0.084).
Methods: Breast cancer patients with parenchymal BM were reviewed from consecutive cases treated at our institution. Cystic BM was defined when the volume of a cystic lesion was greater than 50% of the aggregated volume of all lesions present. Clinicopathologic and radiographic variables were correlated with development of cystic lesions and with prognosis of cystic BM.
Conclusions: This study shows that cystic BM from breast cancer, a special morphological type of BM, had worse prognosis than the more commonly observed solid BM. Younger age and low tumor grade were associated with the development of cystic lesions. Further comprehensive research and management of cystic BM are warranted to improve its poor prognosis.
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