서울의대 / 김재식, 김규보, 김인아*
Abstract
Background: To investigate outcomes of salvage whole-brain radiotherapy (WBRT) for recurrent brain metastases (BM) from breast cancer (BC), to identify prognostic factors of overall survival (OS), and to propose a novel prognostic classification for OS in these patients.
Materials and methods: We identified 54 patients who had received salvage WBRT as the second brain-focused treatment for recurrent BM from BC (2000-2014). The median follow-up duration was 4.9 months. A recursive partitioning analysis (RPA) was conducted to develop a model to predict OS at the time of salvage WBRT.
Results: The median OS was 6.8 months. OS according to BC-specific graded prognostic assessment (breast-GPA), modified breast-GPA, and updated breast-GPA did not represent our cohort. In the multivariate analysis, a long time before salvage WBRT (≥16 months), control of primary BC or extracranial metastases, systemic treatment after salvage WBRT, and administration of a biologically effective dose for an α/β of 10 Gy (BED10) of salvage WBRT >37.5 Gy showed superior OS. We proposed three RPA classes based on the control of both primary BC and extracranial metastasis and BED10 of salvage WBRT: class I, class II, and class III. In this model, patients with class I experienced the best OS (34.6 months; class II, 5.0 months; class III, 2.4 months; P < 0.001).
Conclusions: In our RPA classification according to the control of both primary BC and extracranial metastasis and the dose of salvage WBRT, significant differences in OS were observed. The subsequent use of a systemic treatment showed better OS.
Fig 1. Diagrams of recursive partitioning analysis (RPA). (a) Five terminal nodes before amalgamation. (b) Final three RPA classes after amalgamation.
Fig 2. Overall survival according to the novel recursive partitioning analysis class.
Affiliations
Jae Sik Kim 1 , Kyubo Kim 2 , Wonguen Jung 2 , Kyung Hwan Shin 1 , Seock-Ah Im 3 , Yong Bae Kim 4 , Jee Suk Chang 4 , Doo Ho Choi 5 , Haeyoung Kim 5 , Yeon Hee Park 6 , Dae Yong Kim 7 , Tae Hyun Kim 7 , Jeanny Kwon 8 , Ki Mun Kang 9 , Woong-Ki Chung 10 , Kyung Su Kim 11 , In Ah Kim 12
1 Department of Radiation Oncology, Seoul National University College of Medicine, South Korea.
2 Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea.
3 Department of Internal Medicine, Seoul National University College of Medicine, South Korea.
4 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, South Korea.
5 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
6 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
7 Proton Therapy Center, National Cancer Center, South Korea.
8 Department of Radiation Oncology, Chungnam National University College of Medicine, South Korea.
9 Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, South Korea.
10 Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, South Korea.
11 Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, South Korea; Department of Radiation Oncology, Ewha Womans University College of Medicine, South Korea.
12 Department of Radiation Oncology, Seoul National University College of Medicine, South Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, South Korea. Electronic address: inah228@snu.ac.kr.
편집위원
유방암 뇌전이로 구제 목적의 전뇌방사선치료를 받은 환자의 예후인자를 분석하였고, 원발종양과 두개외 전이종양의 조절상태 및 구제 전뇌방사선치료선량, 그리고 방사선치료 후 전신치료가 생존율에 유의한 인자로 분석됨
2022-01-14 15:40:14