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

[Lani]

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.