目的:报告一组经活检证实的HER-2阳性乳腺癌患者接受立体定向放射外科(SRS)治疗脑转移(BM)的患者的预后和局部肿瘤控制率。
方法:这个国际,回顾性,多中心研究,包括195名女性患者,接受1706SRS治疗的BM。确定SRS后的放射学和临床结果,并确定预后因素。
结果:在SRS,患者年龄中位数为55岁[四分位距(IQR)47.6-62.0],156例(80%)患者KPS≥80。中位肿瘤体积为0.1cm3(IQR0.1-0.5),中位处方剂量为16Gy(IQR16-18)。局部肿瘤控制率(LTC)为98%,94%,93%,90%,88%的人在六点钟,12-,24-,SRS后36个月和60个月,分别。在多变量分析中,肿瘤体积(p=<0.001)和同时使用的帕妥珠单抗(p=0.02)可改善LTC.6-的总生存率(OS),12-,24-,36-,48-,60个月是90%,69%,46%,27%,22%,18%,分别。同时帕妥珠单抗改善OS(p=0.032)。在这个病人亚组中,GPA评分≥2.5(p=0.038和p=0.003)和罕见的原发肿瘤组织学(p=0.01)与OS升高和降低相关,分别。27例(14.0%)患者发生无症状不良放射事件(ARE),5例(2.6%)患者发生有症状ARE。原发性浸润性小叶癌(p=0.042)和并发帕妥珠单抗(p<0.001)增加了总体风险,但没有症状性ARE。
结论:SRS为HER-2阳性乳腺癌BM患者提供有效的LTC。同时帕妥珠单抗改善了LTC和OS,但同时增加了总体风险,但没有症状,ARE.
OBJECTIVE: To report patient outcomes and local tumor control rates in a cohort of patients with biopsy-proven HER-2 positive breast cancer treated with stereotactic radiosurgery (SRS) for brain metastases (BM).
METHODS: This international, retrospective, multicenter
study, included 195 female patients with 1706 SRS-treated BM. Radiologic and clinical outcomes after SRS were determined and prognostic factors identified.
RESULTS: At SRS, median patient age was 55 years [interquartile range (IQR) 47.6-62.0], and 156 (80%) patients had KPS ≥ 80. The median tumor volume was 0.1 cm3 (IQR 0.1-0.5) and the median prescription dose was 16 Gy (IQR 16-18). Local tumor control (LTC) rate was 98%, 94%, 93%, 90%, and 88% at six-, 12-, 24-, 36- and 60-months post-SRS, respectively. On multivariate analysis, tumor volume (p = < 0.001) and concurrent pertuzumab (p = 0.02) improved LTC. Overall survival (OS) rates at six-, 12-, 24-, 36-, 48-, and 60-months were 90%, 69%, 46%, 27%, 22%, and 18%, respectively. Concurrent pertuzumab improved OS (p = 0.032). In this patient subgroup, GPA scores ≥ 2.5 (p = 0.038 and p = 0.003) and rare primary tumor histologies (p = 0.01) were associated with increased and decreased OS, respectively. Asymptomatic adverse radiation events (ARE) occurred in 27 (14.0%) and symptomatic ARE in five (2.6%) patients. Invasive lobular carcinoma primary (p = 0.042) and concurrent pertuzumab (p < 0.001) conferred an increased risk for overall but not for symptomatic ARE.
CONCLUSIONS: SRS affords effective LTC for selected patients with BM from HER-2 positive breast cancer. Concurrent pertuzumab improved LTC and OS but at the same time increased the risk for overall, but not symptomatic, ARE.