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Abstract
PURPOSE:
This study evaluated the influence of prognostic factors and whole brain radiotherapy (WBRT) on overall survival (OS) of breast cancer (BC) patients with brain metastases (BM).

METHODS AND MATERIALS:
Medical records of 730 BC patients diagnosed with BM from 2000 to 2014 at 17 institutions were retrospectively reviewed. OS was calculated from BM diagnosis. Median follow-up duration was 11.9 months (range, 0.1-126.2).

RESULTS:
Median OS was 15.0 months (95% CI: 14.0-16.9). Patients with different BC-specific graded prognostic assessment (GPA) scores showed significant differences (p < 0.001) in OS. In multivariate analysis, histologic grade 3 (p = 0.014), presence of extracranial metastasis (p < 0.001), the number of BM (>4; p = 0.002), hormone receptor negativity (p = 0.005), HER2-negativity (p = 0.003), and shorter time interval (<30 months) between BC and BM diagnosis (p = 0.007) were associated with inferior OS. By summing the β-coefficients of variables that were prognostic in multivariate analyses, we developed a prognostic model that stratified patients into low-risk (≤0.673) and high-risk (>0.673) subgroups; the high-risk subgroup had poorer median OS (10.1 months, 95% CI: 7.9-11.9 vs. 21.9 months, 95% CI: 19.5-27.1, p < 0.001). Univariate and multivariate analyses of propensity score-matched patients diagnosed with BM ≥ 30 months after BC diagnosis (n = 389, "late BM") revealed that WBRT-treated patients showed superior OS compared to non-WBRT-treated patients (p = 0.070 and 0.030, respectively).

CONCLUSION:
Our prognostic model identified high-risk BC patients with BM who might benefit from increased surveillance; if validated, our model could guide treatment selection for such patients. Patients with late BM might benefit from WBRT as initial local treatment.

Author information

Kim JS1, Kim K2, Jung W3, Shin KH1, Im SA4, Kim HJ5, Kim YB6, Chang JS6, Choi DH7, Park YH8, Kim DY9, Kim TH9, Choi BO10, Lee SW10, Kim S11, Kwon J12, Kang KM13, Chung WK14, Kim KS15, Nam JH16, Yoon WS17, Kim JH18, Cha J19, Oh YK20, Kim IA21.
1
Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea.
2
Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea. Electronic address: kyubokim.ro@gmail.com.
3
Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea.
4
Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea.
5
Department of Internal Medicine, Chung-Ang University College of Medicine, Republic of Korea.
6
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Republic of Korea.
7
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.
8
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.
9
Proton Therapy Center, National Cancer Center, Republic of Korea.
10
Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
11
Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea.
12
Department of Radiation Oncology, Chungnam National University College of Medicine, Republic of Korea.
13
Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Republic of Korea.
14
Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Republic of Korea.
15
Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea; Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Republic of Korea.
16
Department of Radiation Oncology, Yangsan Pusan National University Hospital, Pusan National University School of Medicine, Republic of Korea.
17
Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Republic of Korea.
18
Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Republic of Korea.
19
Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Republic of Korea.
20
Department of Radiation Oncology, Chosun University Medical School, Republic of Korea.
21
Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea. Electronic address: inah228@snu.ac.kr.