Recurrent metastatic brain damage in breast cancer: predictors, prognosis, local control

ABSTRACT. In 31–48 % of patients treated for brain metastases in breast cancer, a recurrence of cerebral metastatic lesion develops. A targeted study of recurrent metastatic intracranial lesions in breast cancer aimed at adapting subtypespecific and morphospecific both local and systemic treatment is currently most relevant and has undoubted practical interest.

PURPOSE OF THE STUDY. The study is aimed at determining the nature of recurrent cerebral metastases depending on the method of local first-line exposure, the biological subtype of the tumor, and the morphological properties of the cerebral metastatic process.

MATERIAL AND METHODS. The results of examination and treatment were studied in 162 patients with breast cancer metastasizing to the brain. Recurrent cerebral metastases were diagnosed in 50 (30.8 %) women aged 28 to 80 years. The first-line treatment included tumor resection surgery in 18 (36 %) patients, radiosurgical treatment in 23 (46 %) patients, and whole-brain radiotherapy in 9 (18 %) patients. Patients were stratified by the biological subtype of their primary tumor. All patients were examined according to a standard protocol, applying clinical and laboratory research methods as well as neuroimaging.

RESULTS. Recurrent cerebral metastases were diagnosed in 50 (30.8 %) women. The average age was 52.9±12.3 years. HR+ biological subtype of breast cancer was verified in 16 % (N=8), HR+/HER2+ in 36 % (N=18), and HER2+ and HR-/HER2- in 24 % (N=12) each. In 92 % of cases, metachronous brain metastases were revealed after an average gap of 60.9 months from the verification of the primary tumor. The dependence between the biological tumor subtype and the nature of the primary metastatic brain lesion was not statistically significant (p=0.106). When analyzing how the methods of primary local control influence the variant of a recurrent cerebral lesion, no statistically significant correlation was found (p=0.638). However, a comparative analysis between the studied groups showed significant differences in the nature of cerebral progression. The local recurrence was significantly more common (p=0.001) in the HR+ tumor group, while distant recurrence was inherent to the HR-/HER2- group (p=0.003). The first relapse-free period among all patients was 7.74±8.04 months. None of the biological characteristics specific to the primary tumor influenced the duration of the relapse-free period (p=0.09). The median overall survival in the total number of subjects was 28.5 (Q1 13.25; Q240.75) months. The comparative analysis between groups revealed significant differences in the overall survival rate. The latter was significantly higher in the HER2+ group (p=0.004).

CONCLUSION. Aimed at adapting subtype-specific and morphospecific treatment, both at the local and systemic scale, the study of a recurrent metastatic intracranial lesion in breast cancer is the most relevant option, which demonstrates evident practical efficiency.

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