gms | German Medical Science

Objective: To analyze the feasibility and outcome of stereotactic radiosurgery (SRS) for treatment of brain metastases from breast carcinoma.

Methods: During a 8-year period, 151 patients with 620 brain metastases from breast carcinoma underwent 197 outpatient SRS procedures. 63% of all patients had multiple brain metastases. The median tumor volume was 2.2 cm3 (range: 0.1 – 20.9 cm3). Mean prescribed tumor dose was 19 (+/-4) Gy. Local/distant tumor recurrences were treated by additional radiosurgical treatment for patients with stable systemic disease. All cases were categorized according to the RTOG classification. Survival time and freedom from local tumor recurrence was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazard model.

Results: Overall median survival was 10 months after SRS. The freedom from local brain tumor recurrence after radiosurgery was 94%. Freedom from failure in the brain was 70.2%. Most patients died because of systemically progressing cancer. A Karnofsky Performance Score (KPS) > 70 and RPA class I were related to prolonged survival in the univariate and multivariate analysis. Age, WBRT, surgery, number of metastases, chemotherapy, and latency period from diagnosis of the primary to the development of brain metastases did not reach prognostic relevance in the multivariate model. Patients of RPA class I, II and III survived 34.9 months, 9.1 months and 7.9 months, respectively. There was no permanent morbidity and mortality. Transient morbidity was 17%. Sixteen patients showed symptomatic transient treatment-related complications.

Conclusions: Stereotactic radiosurgery is a feasible treatment concept in selected patients with multiple brain metastases of breast carcinoma.