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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
  • 45 Downloads

Abstract

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 

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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

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