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Journal of Neuro-Oncology

, Volume 112, Issue 3, pp 467–472 | Cite as

The effect of tumor subtype on the time from primary diagnosis to development of brain metastases and survival in patients with breast cancer

  • Paul W. Sperduto
  • Norbert Kased
  • David Roberge
  • Samuel T. Chao
  • Ryan Shanley
  • Xianghua Luo
  • Penny K. Sneed
  • John Suh
  • Robert J. Weil
  • Ashley W. Jensen
  • Paul D. Brown
  • Helen A. Shih
  • John Kirkpatrick
  • Laurie E. Gaspar
  • John B. Fiveash
  • Veronica Chiang
  • Jonathan P.S. Knisely
  • Christina Maria Sperduto
  • Nancy Lin
  • Minesh Mehta
Clinical Study

Abstract

Our group has previously published the Diagnosis-Specific Graded Prognostic Assessment (GPA) showing the prognostic factors associated with survival in patients with brain metastases (BM). The purpose of this study is to investigate the relationship of breast cancer subtype to the time interval from primary diagnosis (PD) to development of BM (TPDBM), number of BM at initial BM presentation and survival. We analyzed our previously described multi-institutional retrospective database of 865 breast cancer patients treated for newly-diagnosed BM from 1993 to 2010. Several factors found to be associated with survival were incorporated into the Breast-GPA, including tumor subtype. The GPA database was further analyzed to determine if the subtype correlated with the TPDBM, number of BM, and survival from PD. After exclusions for incomplete data, 383 patients remained eligible for analysis. The subtypes were approximated as follows: Luminal B: triple positive; HER2: HER2 positive/ER/PR negative; Luminal A; ER/PR positive/HER2 negative; Basal: triple negative. Patients with Basal (90), HER2 (119), Luminal B (98) and Luminal A (76) tumor subtypes had a median TPDBM of 27.5, 35.8, 47.4 and 54.4 months (p < 0.01), median survival from PD of 39.6, 66.4, 90.3 and 72.7 months (p < 0.01) and median survival from BM of 7.3, 17.9, 22.9 and 10.0 months (p < 0.01), respectively. Tumor subtype is an important prognostic factor for survival in patients with breast cancer and BM. Although TPDBM is not an independent prognostic factor for survival (and thus not part of the Breast-GPA), the TPDBM does correlate with tumor subtype but does not correlate with the number of BM. Patients with Basal and HER2 tumor subtypes have short TPDBM. Prospective studies are needed to determine if screening brain MRIs are indicated in patients with Basal or HER2 subtypes.

Keywords

Breast cancer Brain metastases Prognosis Radiation therapy Stereotactic radiosurgery Estrogen Progesterone HER2 Graded prognostic assessment 

Notes

Acknowledgments

Dr. Mehta has served as a consultant to Abbott, Bristol-Meyers-Squibb, Elekta, Genentech, Merck, Novartis, Novocure, Tomotherapy and Viewray; he serves on the Board of Directors of Pharmacyclics, He holds stock options in Pharmacyclics and Accuray. Dr. Lin has served as a consultant to Novartis (<$10 K) and GlaxoSmithKline (<$10 K). Grant Support This research was supported in part by Grant W81XWH-062-0033 from the U.S. Department of Defense Breast Cancer Research Program, to RJW, and by NIH Grant P30- CA77598 utilizing the services of the Biostatistics Core, Masonic Cancer Center, University of Minnesota shared resource.

Conflict of interest

The authors have no conflict of interests.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Paul W. Sperduto
    • 1
    • 19
  • Norbert Kased
    • 2
  • David Roberge
    • 3
  • Samuel T. Chao
    • 4
  • Ryan Shanley
    • 5
  • Xianghua Luo
    • 5
    • 6
  • Penny K. Sneed
    • 2
    • 7
  • John Suh
    • 4
  • Robert J. Weil
    • 7
  • Ashley W. Jensen
    • 8
  • Paul D. Brown
    • 9
  • Helen A. Shih
    • 10
  • John Kirkpatrick
    • 11
  • Laurie E. Gaspar
    • 12
  • John B. Fiveash
    • 13
  • Veronica Chiang
    • 14
  • Jonathan P.S. Knisely
    • 15
  • Christina Maria Sperduto
    • 16
  • Nancy Lin
    • 17
  • Minesh Mehta
    • 18
  1. 1.Minneapolis Radiation Oncology, University of Minnesota Gamma KnifeMinneapolisUSA
  2. 2.Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Radiation OncologyNotre Dame Hospital, University of MontrealMontrealCanada
  4. 4.Department of Radiation OncologyCleveland ClinicClevelandUSA
  5. 5.Masonic Cancer Center, University of MinnesotaMinneapolisUSA
  6. 6.Division of BiostatisticsSchool of Public Health, University of MinnesotaMinneapolisUSA
  7. 7.Department of NeurosurgeryCleveland ClinicClevelandUSA
  8. 8.Department of Radiation OncologySanford Roger Maris Cancer CenterFargoUSA
  9. 9.MD Anderson Cancer CenterHoustonUSA
  10. 10.Harvard Medical School, Massachusetts General HospitalBostonUSA
  11. 11.Department of Radiation OncologyDuke University Medical CenterDurhamUSA
  12. 12.Department of Radiation OncologyUniversity of Colorado School of MedicineAuroraUSA
  13. 13.Radiation OncologyUniversity of Alabama Medical Center at BirminghamBirminghamUSA
  14. 14.Department of NeurosurgeryYale University School of Medicine and Yale Cancer CenterNew HavenUSA
  15. 15.Department of Radiation MedicineHofstra University School of Medicine and North Shore-Long Island Jewish Health SystemManhassetUSA
  16. 16.Dartmouth CollegeHanoverUSA
  17. 17.Department of Medical OncologyDana Farber Cancer InstituteBostonUSA
  18. 18.University of Maryland School of MedicineBaltimoreUSA
  19. 19.WaconiaUSA

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