Long-term surval possible after radiosurgery for brain metastases
 

THIS website PROVES this:)

Rhonda Hoffman

http://www.asco.org/ac/1,1003,_12-00..._20-001,00.asp

Rhonda..Thank you for letting us know about this truly hope filled article.
Tammy

HER2 brain mets live longer
 

I know we are not into survival stats on this board BUT them fact remains that Herceptin + rads in HER2 cancers do way better than their HER(-) counterparts. I seems what used to be a curse (HER2) is now a blessing of sorts. What remains to be studied is HER2 (herceptin) + HER1 (lapatinib, iressa) inhibition stats. What this does suggest however is that the rads really do blow holes into the blood/brain barrier since that would account for the better stats for herceptin treated (as herceptin doesn't cross the B/B barrier.

Al

Improved survival after radiotherapy for brain metastases in patients with HER2 positive breast tumors.

Maur M, Frassoldati A, Piacentini F, Ramundo D, Sabbatini R, Giovannelli S, Ficarra G, Bertolini F, Falchi AM, Conte PF. University of Modena and Reggio Emilia, Modena, Italy

Background: A high incidence of brain metastases (BM) has been reported in patients with HER2 positive breast tumors. This could be the combined result of more aggressive tumor biology and better control of systemic disease with trastuzumab. In order to define how HER2 status affect the CNS involvement and the response to radiotherapy we conducted a retrospective chart review of patients (pts) with BM.
Patients and methods: Data from 53 consecutive patients with BM from BC were retrieved. Median age at CNS progression was 56 years (range 33 to 76); 38/53 pts (71%) had two or more CNS metastases (23 brain, 6 cerebellum, 14 brain/cerebellum, 3 brain/cerebellum/leptomeningeal), 43/53 pts (81%) had multiple extra cranial metastases. Median time to developing CNS mts after primary diagnosis was 50 months (range 32 to 236). Forty-one pts (77%) had received prior chemotherapy (37/53 antracycline-based, 21/53 taxane-based). The tumor biological characteristics were as follows: high grade 27/53 (51%), high proliferative rate (MIB-1 > 20%) 33/53 (62%), ER positive 23/53 (43%), PgR positive 12/53 (22%). Twenty-five (47%) were HER2 positive. Three patients only underwent to brain metastasectomy. Forty-nine pts were treated with whole brain radiotherapy (WBR) plus prednisolone (28 pts 30 Gy/10 fractions, 21 pts 20 Gy/5 fractions) and 4 pts had received stereotassic radiosurgery (SRS). At the time of diagnosis of BM 16/53 (30%) were on treatment with trastuzumab.
Results: No significant correlation between site of CNS relapse and tumor histology (p=0.877), grading (p=0.495), HER2 status (p=0.127), ER status (p=0.499), PgR status (p=0.152), anthracycline based (p=0.998) or taxane-based chemotherapy (p=0.756) was observed. The response status after radiotherapy was: 1 complete response (CR), 20 (57%) partial response (PR), 11 (31%) stable disease (SD), 3 (8.5%) progression disease (PD), response was not assessed in 18 pts. No difference between type of response to radiotherapy and histology (p=0.681), grading (p=0.183), HER2 status (p=0.844), CNS metastatic site (p=0.116), number of CNS mts (p=0.677) and trastuzumab-therapy (p=0.389) was observed. A significant better response was observed with high dose (30 Gy/10 fractions) of WBR (p= 0.01). So far 38/53 (72%) died for disease progression, 13/53 (25%) are alive with disease. Median survival of all pts was 9 mos. Significant predictors for better overall survival were: HER2 status (positive 21 mos vs negative 3 mos, p= 0.005), age (< 55 years 10 mos vs > 55 years 3 mos, p= 0.007) and among HER2 positive patients continuous treatment with trastuzumab (yes 21 mos vs no 5 mos, p=0.026).
Conclusions: breast cancer patients with HER2 positive BM experience a more long survival when treated with radiotherapy and trastuzumab.

Saturday, December 10, 2005 7:00 AM

I want to add to this, that in my consultation process for stereotatic surgery for brain mets, I've been told BC brain mets responds better to the procedures than brain lesions of other origins. They don't know why.

Age, if the lesions are less than 3 cm, and if there are less than 4 lesions all have an impact on final results as well.

The patient that does the best with Gamma Knife, X-knife, Cyber-Knife is the BC mets patient, with either no disease or controlled disease elsewhere in the body, few other health problems, high functioning physically, 4 lesions or less, and lesions 3 cm or less.