Is early recognition of radiologically silent brain metastasis from breast cancer beneficial? A retrospective study of 22 cases
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Over a period of 10 years, twenty-two patients with T2-3N2Mx breast cancer presented with symptoms of increased intracranial pressure (ICP), but brain CT scan and/or MRI didnot reveal any signs of a space occupying lesion. A brain CT scan and an MRI study were performed every 15 days. Ten patients refused this close follow up. Thus, two groups were formed group A (n = 12) included the patients who were close’s followed and group B (n = 10) consisted of those patients who were not. Therefore, Group A, being under careful follow-up, initiated radiotherapy were quickly. The median time from the presentation of increased ICP symptoms until the appearance of metastases on CT and/or MRI directly followed by brain irradiation was 48 days (SE = 6.1) for group A and 72 days (SE = 0.7) for group B (p = 0.0085, log-rank test). In group A, median Overall Survival (OS) was 171.0 (SE = 21.5) days, and was 99.0 (SE = 6.3) days (p = 0.014) for group B. Volumetric analysis of the secondary brain lesions at the initiation of radiotherapy showed a total volume of metastatic lesions of 19.5 ± 13.9 cm3 versus 65.3 ± 20.7 cm3 for groups A and B, respectively (p < 0.001, Mann-Whitney test). Post-radiotherapy, Karnofsky Performance Status and Visual Analogue Score were also improved for group A versus B(p= 0.002). Group A appeared to benefit from close follow-up since the metastases were detected and irradiation was given sooner compared with group B, thus achieving better performance status and prolonged survival. Radiologically silent brain metastases from breast cancer should not be ignored because timely whole brain irradiation should be the goal of clinicians. Clinical suspicion should lead to close followp with multiple CT/MRI studies and cerebral spinal fluid cytology until the final diagnosis.
Key wordsBrain metastasis Early symptoms Increased intracranial pressure Radiotherapy Breast cancer
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- 5).Marcou Y, Lindquist C, Adams C, Retsas S, Plowman PN: What is the optimal therapy of brain metastases?Clin Oncol (R Coll Radiol) 13:105–111, 2001.Google Scholar
- 9).Siegel S. and Castellan Jr J: Nonparametric Statistics for the Behavioral Sciences, McGraw Hill: College Div: 2nd edition: 1988.Google Scholar
- 16).Agboola O, Benoit B, Cross P, Da Silva V, Esche B, Lesiuk H, Gonsalves C: Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases.Int J Radiat Oncol Biol Phys 42:155–159, 1998.PubMedGoogle Scholar
- 18).Ryan GF, Ball DL, Smith JG: Treatment of brain metastases from primary lung cancer.Int J Radiat Oncol Biol Phys 31:273–278, 1994.Google Scholar
- 19).Jacot W, Quantin X, Boher JM, Andre F, Moreau L, Gainet M, Depierre A, Quoix E, Chevalier TL, Pujol JL: Association d’Enseignement et de Recherche des Internes en Oncologie.: Brain metastases at the time of presentation of non-small cell lung cancer: a multi-centric AERIO analysis of prognostic factors.Br J Cancer 84(suppl 7):903–909, 2001.PubMedCrossRefGoogle Scholar