New brain metastases after whole-brain radiotherapy of initial brain metastases in breast cancer patients: the significance of molecular subtypes (KROG 16-12)
- Kim, Jae Sik; Kim, Kyubo; Jung, Wonguen; Shin, Kyung Hwan; Im, Seock-Ah; Kim, Hee-Jun; Kim, Yong Bae; Chang, Jee Suk; Kim, Jee Hyun; Choi, Doo Ho; Park, Yeon Hee; Kim, Dae Yong; Kim, Tae Hyun; Choi, Byung Ock; Lee, Sea-Won; Kim, Suzy; Kwon, Jeanny; Kang, Ki Mun; Chung, Woong-Ki; Kim, Kyung Su; Yoon, Won Sup; Kim, Jin Hee; Cha, Jihye; Oh, Yoon Kyeong; Kim, In Ah
- Issue Date
- Brain-directed treatment; Brain metastasis; Breast cancer; Tumor molecular subtype; Whole-brain radiotherapy
- BREAST CANCER RESEARCH AND TREATMENT, v.186, no.2, pp.453 - 462
- Journal Title
- BREAST CANCER RESEARCH AND TREATMENT
- Start Page
- End Page
- Purpose To identify the risk factors leading to new brain metastases (BM) following brain-directed treatment for initial BM resulting from breast cancer (BC). Methods In this multi-institutional study, 538 BC patients with available follow-up imaging after brain-directed treatment for initial BM were analyzed. Tumor molecular subtypes were classified as follows: hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-, n = 136), HER2-positive (HER2+, n = 253), or triple-negative BC (TNBC, n = 149). Results In 37.4% of patients, new BM emerged at a median of 10.5 months after brain-directed treatment for initial BM. The 1-year actuarial rate of new BM for HR+/HER2-, HER2+, and TNBC were 51.9%, 44.0%, and 69.6%, respectively (p = 0.008). Initial whole-brain radiotherapy (WBRT) reduced new BM rates (22.5% reduction at 1 year, p < 0.001) according to molecular subtype (HR+/HER2-, 42% reduction at 1 year, p < 0.001; HER2+, 18.5%, p = 0.004; TNBC, 16.9%, p = 0.071). Multivariate analysis revealed an increased risk of new BM for the following factors: shorter intervals between primary BC diagnoses and BM (p = 0.031); TNBC (relative to HR+/HER2-) (p = 0.016); presence of extracranial metastases (p = 0.019); number of BM (>4) (p < 0.001); and BM in both tentorial regions (p = 0.045). Anti-HER2 therapy in HER2+ patients (p = 0.013) and initial use of WBRT (p < 0.001) significantly lowered new BM development. Conclusions Tumor molecular subtypes were associated with both rates of new BM development and the effectiveness of initial WBRT. Anti-HER2 therapy in HER2+ patients significantly lowered new BM occurrence.
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- College of Medicine > Department of Medicine > Journal Articles
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