The clinicopathologic features of breast cancer pati̇ents wi̇th brain metastases

ABSTRACT Breast cancer is the second most common cause of central nervous system metastases. Due to the developments in the treatment of patients of breast cancer, which is the most common cancer in women; prolonged survival and increased incidence of brain metastasis of breast cancer is seen. There are many factors that affect overall survival, disease-free survival, and response to treatment in patients with brain metastasis of breast cancer. Different communities and races respond differently to the treatment due to pharmacogenetic differences. In this study, 38 patients with brain metastases of breast cancer which were followed up in Baskent University Faculty of Medicine, Department of Medical Oncology from 2000 to 2009 were examined retrospectively. In these patients, the effects of clinical and pathological factors (patient's age, menopausal status, tumor type, stage, grade, HER2 -Epidermal Growth Factor Receptor-2, Cerb-B2- and hormonal properties, local and systemic treatments) on brain metastasis-free survival and overall survival were investigated. In addition, brain metastasis-free and overall survival rates of patients were examined. All results were compared with the results of the previous studies. Patients'median age was 48 (range 20-72). In this study, significant effect of greater stage on reducing the amount of time needed for development of brain metastasis was found (p = 0.018). An increasing the time effect of metastase number, on the amount of time needed for development of brain metastases was detected (p = 0.032). The decreasing risk of developing brain metastasis with the increased number of chemotherapy lines (p = 0.003) was dedected. The number of chemotherapy lines was found to be the most effective factor on the brain metastasis growth rate (p <0.001). The most effective factors that increases overall survival were found to be the number of chemotherapy lines and hormonotherapy (respectively, p = 0.03 and p = 0.04). It was observed that other factors had no effect on the prognosis significantly. It was calculated that the median value of time interval from the diagnosis of breast cancer to the development of brain metastasis was 29 months (2-90), the median survival after the development of brain metastasis was 6 months, and median overall survival time was 34.5 (range, 11-113 months) months. vi As a result, although the prognosis of breast cancer patients with brain metastases is still poor, significant progress has been achieved when it is compared with the past. Đnstead of the previously reported significant prognostic factors as Karnofsky performance score, younger age, estrogen receptor positivity, progesterone receptor positivity, and HER2 status; it was found that stage, number of metastases, and number of chemotherapy lines were significant prognostic factors on the brain metastase-free survival; hormonotherapy and number of chemotherapy lines were significant prognostic factors on the overall survival. Even for patients with good prognostic factors, new treatment approaches are needed for breast cancer cases with brain metastases.