Would you do WBR a Second Time?? Advice ASAP Please

[Lani]

I separately posted the following in 4/2009 from that same Lani, Sneed search:

IMPORTANT LESSONS--UCSF reviews 14 years of experience with gamma knife treatment of
brain mets from metastatic breast cancer

Lessons (if prove out in others studies as well)--

1)upfront whole brain radiation therapy may not improve things vs upfront gamma knife

2) having more mets may not be associated with a ahorter survival time than having few mets !!!

As with other studies, her2 +ivity associated with longer survival



Int J Radiat Oncol Biol Phys. 2009 Apr 2. [Epub ahead of print]

Gamma Knife Radiosurgery for Brain Metastases from Primary Breast Cancer.

Kased N, Binder DK, McDermott MW, Nakamura JL, Huang K, Berger MS, Wara WM, Sneed PK.
Departments of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA.
PURPOSE: The relative roles of stereotactic radiosurgery (SRS) vs. whole brain radiotherapy (WBRT) in the treatment of patients with brain metastases from breast cancer remain undefined. In this study, we reviewed our experience with these patients. MATERIALS AND METHODS: We retrospectively reviewed all patients treated between 1991 and 2005 with Gamma Knife SRS for brain metastases from breast cancer. The actuarial survival and freedom from progression endpoints were calculated using the Kaplan-Meier method. RESULTS: Between 1991 and 2005, 176 patients underwent SRS for brain metastases from breast cancer. The median survival time was 16.0 months for 95 newly diagnosed patients and 11.7 months for 81 patients with recurrent brain metastases. In the newly diagnosed patients, omission of upfront WBRT did not significantly affect the MST (p = .20), brain freedom from progression (p = .75), or freedom from new brain metastases (p = .83). Longer survival was associated with age <50 years, Karnofsky performance score >/=70, primary tumor control, estrogen receptor positivity, and Her2/neu overexpression. No association was found between the number of treated brain metastases and the survival time. CONCLUSION: We have described prognostic factors for breast cancer patients treated with SRS for newly diagnosed or recurrent brain metastases. Most patient subsets had a median survival time of >/=11 months. Unexpectedly, upfront WBRT did not appear to improve brain freedom from progression, and a larger number of brain metastases was not associated with a shorter survival time. Breast cancer might be distinct from other primary sites in terms of prognostic factors and the roles of WBRT and SRS for brain metastases.
PMID: 19345514


Hope this helps!