letter from CANCER delineating those who warrant to be followed with brain MRIs

[Lani]

I provide this for those to whom it applies to cite

It is only a letter to a leading journal, whereas those oncologists who "follow" will wait until it is published as consensus recommendation

Those factors which caught my eye were that it was younger, ER+, her2+ who only had one met (ie, treatable with cyberknife), whose first met was to the CNS who had the chance for longest survival

Those who are her2+ ER- should also note that they are more at risk of the mets in the first place and once tykerb/lapatinib becomes available their survival may be altered (let's all hope!)

I hope this is not too scary, Rather to be used as ammunition to prevent the
mets from appearing and colonizing undetected due to unwillingness of oncologists to try to detect early when most treatable(will post fascinating article of incredible high tech model of how brain mets occur)

Hope this helps!

[Lani]

Primary breast cancer phenotypes associated with propensity for central nervous system metastases
Kadri Altundag, MD
Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
We congratulate Tham et al. for their retrospective study, in which they attempted to define an association between primary breast cancer phenotype and a propensity for central nervous system (CNS) metastases.[1] They demonstrated that younger patients with hormone receptor-negative, highly proliferative, genomically unstable, and p53-altered tumors were at an increased relative risk for CNS metastases. In their analysis, the median survival after a diagnosis of CNS metastases was 5.5 months in 383 patients. On univariate analysis, they did not find any association between survival and the clinicopathologic characteristics of the patients with the exception of HER-2 status. Patients with HER-2 overexpression were found to have a shorter survival.

A recent retrospective study evaluated clinical data from 420 patients who had been diagnosed with breast cancer and CNS metastases between 1994 and 2004 at the University of Texas M. D. Anderson Cancer Center. In this study, the median follow-up after a diagnosis of CNS metastases was 6 months (range, 0.7-95.9 months) and the overall median survival was 6.8 months.[2] On univariate analysis, patients with younger age, positive hormone receptor status, a single CNS metastatic lesion, and CNS metastases as the site of first metastases were found to have significantly better survival. However, only age at diagnosis and estrogen receptor (ER) status were found to be significantly associated with overall survival on multivariate analysis. Patients with ER-positive disease tended to have a longer overall survival compared with patients with ER-negative disease (P = .003). Patients age 50 years tended to have a longer overall survival compared with patients age >50 years(P = .047). HER-2 status was not included in this analysis because of the large amount of missing data associated with this characteristic.

In conclusion, although the survival of patients with breast cancer metastases to the CNS is generally poor, there are some long-term survivors reported, such as younger patients with hormone receptor-positive histology and a single CNS metastatic lesion. More aggressive treatment approaches may be considered for these patients.

References

1 Tham YL, Sexton K, Kramer R, Hilsenbeck S, Elledge R. Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer. 2006; 107: 696-704. Links
2 Altundag K, Bondy ML, Kau SW, et al. Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastases. Breast Cancer Res Treat. 2005; 94 ( Suppl 1): S143. Abstract 3056. Links

[Lani]

interestingly of the cells injected only a small percentage (the stem cells) were capable of forming mets and they showed dormancy (lack of cell division for long periods of time--like bathroom mold)

They labeled the cells with a substance which was very highly magnetic so the tiniest amount, associated with a single cell, could show up on MRI!!!

Magn Reson Med. 2006 Oct 6; [Epub ahead of print] Links
In vivo MRI of cancer cell fate at the single-cell level in a mouse model of breast cancer metastasis to the brain.

Heyn C,
Ronald JA,
Ramadan SS,
Snir JA,
Barry AM,
Mackenzie LT,
Mikulis DJ,
Palmieri D,
Bronder JL,
Steeg PS,
Yoneda T,
Macdonald IC,
Chambers AF,
Rutt BK,
Foster PJ.
Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada.
Metastasis (the spread of cancer from a primary tumor to secondary organs) is responsible for most cancer deaths. The ability to follow the fate of a population of tumor cells over time in an experimental animal would provide a powerful new way to monitor the metastatic process. Here we describe a magnetic resonance imaging (MRI) technique that permits the tracking of breast cancer cells in a mouse model of brain metastasis at the single-cell level. Cancer cells that were injected into the left ventricle of the mouse heart and then delivered to the brain were detectable on MR images. This allowed the visualization of the initial delivery and distribution of cells, as well as the growth of tumors from a subset of these cells within the whole intact brain volume. The ability to follow the metastatic process from the single-cell stage through metastatic growth, and to quantify and monitor the presence of solitary undivided cells will facilitate progress in understanding the mechanisms of brain metastasis and tumor dormancy, and the development of therapeutics to treat this disease. Magn Reson Med, 2006. Published 2006 Wiley-Liss, Inc.
PMID: 17029229 [PubMed - as supplied by publisher]