Breast Cancer

, Volume 11, Issue 3, pp 276–281 | Cite as

Is early recognition of radiologically silent brain metastasis from breast cancer beneficial? A retrospective study of 22 cases

  • Kyriaki Mystakidou
  • Vassilis Kouloulias
  • Eleni Tsilika
  • Efstathios Boviatsis
  • John Kouvaris
  • George Matsopoulos
  • Lambros Vlahos
Original Article


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 words

Brain metastasis Early symptoms Increased intracranial pressure Radiotherapy Breast cancer 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1).
    Soffietti R, Ruda R, Mutani R: Management of brain metastases.J Neurol 249:1357–1369, 2002.PubMedCrossRefGoogle Scholar
  2. 2).
    Sze G, Milano E, Johnson C, Heier L: Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT.AJNR Am J Neuroradiol 11:785–791, 1990.PubMedGoogle Scholar
  3. 3).
    Mahmoud-Ahmed AS, Suh JH, Lee SY, Crownover RL, Barnett GH: Results of whole brain radiotherapy in patients with brain metastases from breast cancer: a retrospective study.Int J Radiat Oncol Biol Phys 54:810–817, 2002.PubMedGoogle Scholar
  4. 4).
    Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR: The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group.Int J Radiat Oncol Biol Phys 6:1–9, 1980PubMedGoogle Scholar
  5. 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
  6. 6).
    Fokstuen T, Wilking N, Rutqvist LE, Wolke J, Liedberg A, Signomklao T, Fernberg JO: Radiation therapy in the management of brain metastases from breast cancer.Breast Cancer Res Treat 62:211–216, 2000.PubMedCrossRefGoogle Scholar
  7. 7).
    Delibasis KK, Matsopoulos GK, Mouravliansky NA, Nikita KS: Novel surface reconstruction techniques for visualization of medical data.Stud Health Technol Inform 79:442–462, 2000.PubMedGoogle Scholar
  8. 8).
    Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration.Cancer Chemother Rep 50:163–170, 1966.PubMedGoogle Scholar
  9. 9).
    Siegel S. and Castellan Jr J: Nonparametric Statistics for the Behavioral Sciences, McGraw Hill: College Div: 2nd edition: 1988.Google Scholar
  10. 10).
    Alexander E 3rd, Loeffler JS: The case for radio-surgery.Clin Neurosurg 45:32–40, 1999.PubMedGoogle Scholar
  11. 11).
    Skjoeth J, Bjerre PK: Effect of glucocorticoids on ICP in patients with a cerebral tumor.Acta Neurol Scand 96:167–170, 1997.PubMedCrossRefGoogle Scholar
  12. 12).
    Hirsch FR, Paulson OB, Hansen HH, Vraa-Jensen J: Intracranial metastases in small cell carcinoma of the lung: correlation of clinical and autopsy findings.Cancer 50:2433–2437, 1982.PubMedCrossRefGoogle Scholar
  13. 13).
    Allanore Y, Hilliquin P, Zuber M, Renoux M, Menkes CJ, Kahan A: A leptomeningeal metastasis revealed by sciatica,Rev Rhum Engl Ed 66:232–234, 1999.PubMedGoogle Scholar
  14. 14).
    Galanis E, Buckner JC, Novotny P, Morton RF, Mc-Ginnis WL, Dinapoli R, Schomberg P, O’Fallon JR: Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas.J Neurosurg 93:201–207, 2000.PubMedCrossRefGoogle Scholar
  15. 15).
    Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI: Identification of prognostic factors in patients with brain metastases: a review of 1292 patients.Int J Radiat Oncol Biol Phys 43:795–803, 1999.PubMedGoogle Scholar
  16. 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
  17. 17).
    Hsiung CY, Leung SW, Wang CJ, Lo SK, Chen HC, Sun LM, Fang FM: The prognostic factors of lung cancer patients with brain metastases treated with radiotherapy.J Neurooncol 36:71–77, 1998.PubMedCrossRefGoogle Scholar
  18. 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. 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
  20. 20).
    Kim DG, Chung HT, Gwak HS, Paek SH, Jung HW, Han DH: Gamma knife radiosurgery for brain metastases: prognostic factors for survival and local control.J Neurosurg 93(Suppl 3):23–29, 2000.PubMedGoogle Scholar
  21. 21).
    Schoeggl A, Kite K, Ertl A, Reddy M, Bavinzski G, Schneider B: Prognostic factor analysis for multiple brain metastases after gamma knife radiosurgery: results in 97 patients.J Neurooncol 42:169–175, 1999.PubMedCrossRefGoogle Scholar
  22. 22).
    Becker G, Jeremic B, Engel C, Buchgeister M, Paulsen F, Duffner F, Meisner C, Bamberg M: Radiosurgery for brain metastases: the Tuebingen experience.Radiother Oncol 62(suppl 2):233–237, 2002.PubMedCrossRefGoogle Scholar
  23. 23).
    Nieder C, Berberich W, Schnabel K: Tumor-related prognostic factors for remission of brain metastases after radiotherapy.Int J Radiat Oncol Biol Phys 39(suppl 1):25–30, 1997.PubMedGoogle Scholar
  24. 24).
    Siegfried J, Wellis G, Scheib S, Haller D, Landolt AM, Lomax NJ, Mindermann T, Schubiger O, Wichmann W: Palliative treatment of brain metastases with gamma knife.Ther Umsch 58(suppl 7):413–418, 2001.PubMedCrossRefGoogle Scholar
  25. 25).
    Ringelstein EB, Zeumer H, Hacke W, Keulers P: Computed tomographic brain scanning in the diagnosis of metastatic neoplasms.Dtsch Med Wochenschr 106:1566–1571, 1981.PubMedGoogle Scholar
  26. 26).
    Khansur T, Sanders J, and Das SK: Evaluation of staging workup in malignant melanoma.Arch Surg 124:847–849, 1989PubMedGoogle Scholar
  27. 27).
    Ransohoff J, Smith D: Surgical Treatment of Metastatic Brain Tumors.Cancer Control 2:315–319, 1995.PubMedGoogle Scholar
  28. 28).
    Yu H, Mitsumori M, Nagata Y, Katakura Y, Kokubo M, Oya N, Fujishiro S, Sasai K, Hiraoka M, Kan N: Meningeal carcinomatosis in patients with breast cancer: report of 8 patients.Breast Cancer 8:74–78, 2001.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2004

Authors and Affiliations

  • Kyriaki Mystakidou
    • 1
  • Vassilis Kouloulias
    • 2
    • 5
  • Eleni Tsilika
    • 1
  • Efstathios Boviatsis
    • 3
  • John Kouvaris
    • 2
  • George Matsopoulos
    • 4
  • Lambros Vlahos
    • 1
  1. 1.Palliative care unit, Department of RadiologyGreece
  2. 2.Department of RadiotherapyAreteion Hospital, Medical School, University of AthensGreece
  3. 3.Department of NeurosurgeryEvagelismos Hospital, Medical School, University of AthensGreece
  4. 4.lnstitute of Communication and Computer SystemsNational Technical University of AthensGreece
  5. 5.Radiation OncologistPireusGreece

Personalised recommendations