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Abstract
Purpose: We aimed to compare the initial and salvage brain-directed treatment and overall survival (OS) between patients with 1-4 brain metastases (BMs) and those with 5-10 from breast cancer (BC). We also organized a decision tree to select the initial whole-brain radiotherapy (WBRT) for these patients.

Methods: Between 2008 and 2014, 471 patients were diagnosed with 1-10 BMs. They were divided into two groups based on the number of BM: 1-4 BMs (n = 337) and 5-10 BMs (n = 134). Median follow-up duration was 14.0 months.

Results: Stereotactic radiosurgery (SRS)/fractionated stereotactic radiotherapy (FSRT) was the most common treatment modality (n = 120, 36%) in the 1-4 BMs group. In contrast, 80% (n = 107) of patients with 5-10 BMs were treated with WBRT. The median OS of the entire cohort, 1-4 BMs, and 5-10 BMs was 18.0, 20.9, and 13.9 months, respectively. In the multivariate analysis, the number of BM and WBRT were not associated with OS, whereas triple-negative BC and extracranial metastasis decreased OS. Physicians determined the initial WBRT based on four variables in the following order: number and location of BM, primary tumor control, and performance status. Salvage brain-directed treatment (n = 184), mainly SRS/FSRT (n = 109, 59%), prolonged OS by a median of 14.3 months.

Conclusion: The initial brain-directed treatment differed notably according to the number of BM, which was chosen based on four clinical factors. In patients with ≤ 10 BMs, the number of BM and WBRT did not affect OS. The major salvage brain-directed treatment modality was SRS/FSRT and increased OS.

표1. 전체 생존율에 대한 단변량 및 다변량 분석

그림 1. Salvage 치료 여부에 따른 전체 생존율 곡선

Affiliations

Jae Sik Kim # 1, Kyubo Kim # 2, Wonguen Jung 2, Kyung Hwan Shin 1, Seock-Ah Im 3, Hee-Jun Kim 4, Yong Bae Kim 5, Jee Suk Chang 5, Jee Hyun Kim 3, Doo Ho Choi 6, Yeon Hee Park 7, Dae Yong Kim 8, Tae Hyun Kim 8, Byung Ock Choi 9, Sea-Won Lee 9 10, Suzy Kim 11, Jeanny Kwon 12, Ki Mun Kang 13, Woong-Ki Chung 14, Kyung Su Kim 1 15, Won Sup Yoon 16, Jin Hee Kim 17, Jihye Cha 18, Yoon Kyeong Oh 19, In Ah Kim 20 21
1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
2Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea.
3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
4Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
5Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
6Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
7Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
8Proton Therapy Center, National Cancer Center, Seoul, Korea.
9Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
10Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
11Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
12Department of Radiation Oncology, Chungnam National University College of Medicine, Daejeon, Korea.
13Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.
14Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.
15Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea.
16Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan-Si, Korea.
17Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
18Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju-Si, Korea.
19Department of Radiation Oncology, Chosun University Medical School, Gwangju, Korea.
20Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. inah228@snu.ac.kr.
21Department of Radiation Oncology, Seoul National University Bundang Hospital, Gumi-Ro 173, 82 Beon-Gil, Bundang Gu, Seongnam, 13620, Republic of Korea. inah228@snu.ac.kr.
#Contributed equally.