Occult (silent, asymptomatic) brain metastases in her2+ patients
 

Citation: European Journal of Cancer Supplements Volume 4, No. 2, March 2006, page 164

A. Niwinska1, M. Tacikowska2, T. Pienkowski1, I. Lemanska1, B. Bauer1, H. Rudnicka1

1Maria Sklodowska-Curie Memorial Cancer Center, Breast Cancer and Reconstructive Surgery Department, Warsaw, Poland
2Maria Sklodowska-Curie Memorial Cancer Center, Radiology Department, Warsaw, Poland

Aim: The aim of the prospective study was to evaluate the frequency of occult brain metastases in breast cancer pts with HER-2 receptor overexpression, and to analyze overall survival and the cause of death of patients (pts) after whole brain radiotherapy (WBRT).
Material and Methods: MRI screening examination of the brain was performed in 60 HER-2 positive breast cancer pts currently treated in Breast Cancer Clinic with trastuzumab and chemotherapy because of visceral metastases and/or locoregional failure. In case of pts with occult brain metastases detected, the irradiation to the brain 30 Gy in 10 fraction was undertaken. Then, control MRI was planned to be performed 3, 6, 9, 12 months after radiotherapy in order to assess the extent of regression of metastases.
Results: In 20 (33%) pts occult brain metastases were detected: in 7 – solitary, in 13 – numerous. Pts with brain metastases were younger than those without them (median age at primary breast cancer 48 years vs 52 years), and more often with distant metastases to lungs and/or liver (18/20 pts). Median time from recurrence of the disease (visceral metastases/locoregional failure) to brain metastases was 9 months, mean 11 months. From among 10 patients with time of observation of at least 1 year after WBRT, 5 pts are still alive without symptoms of brain metastases, 5 patients died: 4- due to progression in viscera and only 1- because of progression in brain.
Conclusion: Our prospective study confirms high percentage of occult brain metastases in HER-2 positive breast cancer pts. Mean time of detection of occult brain metastases does not exceed 1 year from recurrence of the disease. Brain metastases after WBRT undertaken during asymptomatic period are not the main cause of death of breast cancer patients. In most cases those patients die of visceral metastases. It seems that it is reasonable to introduce MRI screening of the brain in HER-2 positive breast cancer pts with disseminated disease for early detection and irradiation of brain metastases before neurological symptoms appear. Longer follow-up period is necessary in order to assess the cause of death of pts.

Re: Occult (silent, asymptomatic) brain metastases in her2+ patients
 

Bringing up this old post as this study gave Joe and Christine what they needed to pursue with Dr. Winer and other important oncology thinkers the need for screening especially HER2 positive breast cancer patients.

Everyone should be aware that this is a possibility - brain mets can occur and be successfully treated. I am just very sorry that our Courtney and NEDenise were not among those numbers.

Re: Occult (silent, asymptomatic) brain metastases in her2+ patients
 

Wow. All. Can say is that my daughter fits all the criteria above, was screened for headaches that turned out to be not related to the numerous (about a dozen) brain mets discovered on MRI, 8 months after her diagnosis as stage IV with mets to liver. Dr. Winer is head of the Breast Oncology Dept at Dana Farber where she is being treated, and they do not scan routinely for brain mets for women with her profile-- young, her2+, visceral mets. I am only thankful her oncologist is proactive about any possible symptoms. She's had WBR and is doing well, will be scanned next month for results. Her oncologist told her exactly what the study above suggests, that the liver mets were considered primary in terms of her prognosis, not the brain mets. I am so sorry about Courtney and NEDenise. :-'( Thank you, Lani & Steph.

Re: Occult (silent, asymptomatic) brain metastases in her2+ patients
 

I guess my daughter Susan would be considered a success story initially as for the brain mets.
I think each case is an individual unique experience.
As I have previously posted, the original diagnoses was 2003 - invasive ductal. In less than two years - approximately 2005 it went to the hip bone. She went through a vaccine trial at John's Hopkins where she thought she was one of the ones who seemed to benefit at the time. However no boosters were ever available.
It was late summer of 2009 when she began vomiting - thought she had the flu. MRI showed a very large tennis ball sized tumor on the cerebellum. Had no previous warning signs - so definitely occult.
The surgeon in Miami told her removing it might leave her "gimpy". However it did not. He removed it all without problems. She then had WBR. returned to feeling good.
She seemed free of the tumors on subsequent MRIs.
It was spring of 2012 when the MRI showed the growths in the spine - larger in the thoracic region.
Also was noted a few dots on the cerebellum. Not known if this was tumors or scar tissue.
Must have been small tumors as they are gone now after the ommaya and spine punctures with Herceptin. and the Emend.
Emend has a track record of crossing the blood brain barrier and erasing tumors besides helping with the nausea.
Every case is individual. I do not think generalities apply.

Ev
http://www.news-medical.net/news/201...or-growth.aspx

Re: Occult (silent, asymptomatic) brain metastases in her2+ patients
 

I had been having routine brain MRI's before a tiny tumor was found in the cerebellum, when I first asked the Doctor, he was a little reluctant, but oblige. Last year when the small tumor was visible on the MRI he thanked me for asking him to order the MRI's.

It's crucial to work with your doctor- - talk to him/her all the time, ask questions, even if you think it's not important or sounds silly- - it may take a while before mets to the brain are discovered, by then a patient may have too many tumors to have them treated on a single treatment - not visits- but it's a better alternative then having WBR.

Had I not been a member of this organization I wouldn't have known to ask my doctor.

Thank you Stephanie for mentioning the importance of this and also our beloved Sheila, whom I thanked many, many times before she left us.

I'm so thankful for this site and everyone who I have come across in the past ten years. They are not just my only and true heroes, but my Warriors, they saved my life.

Love,

Adriana

Re: Occult (silent, asymptomatic) brain metastases in her2+ patients
 

Thank you Steph. I make sure I get brain scans, one way or another I do what I have to do to get the doctor to order them.

Re: Occult (silent, asymptomatic) brain metastases in her2+ patients
 

Are brain scans dangerous in terms of radiation exposure? Apart from the MRI and pet scans at diagnosis, my oncologist does not routinely suggest them in the absence of systems (which this thread suggests might be mistake?).