Abstract 1484
Background
BM occur in up to 30% of patients with BC. SRS can be considered as an alternative to surgery or whole brain radiotherapy for control of single or multiple metastases. Factors that could predict overall survival (OS) and guide treatment choice have not been clearly defined.
Methods
Data for consecutive patients with BC treated with SRS between November 2013 and August 2017 in a single tertiary referral centre were collected to assess factors that might predict survival. T-tests, Kaplan Meier and log-rank methods were used for statistical analysis.
Results
93 patients (pts) received SRS, of whom 32 were alive when data was censored on 1/2/18. The median overall survival (OS) post SRS was 14.0 mths (95% C.I +/- 2.4mths) with a significant correlation between age and OS (53 pts ≤60yr, OS = 18.1mths; 43pts >60y OS = 10.3mths, r=-0.21, p = 0.04). There were 31 ER+/HER2- pts (OS 15.2mths), 14 ER+/HER2+ pts (OS 31.9mths), 30 ER-/HER2+ pts (OS 22.8mths) and 16 Triple negative (TN) pts (OS 8.5mths). OS was significantly better for pts with HER2+ disease (p = 0.0018) with the poorest survival in pts with TN cancer (p = <0.0001). 39pts had 1 lesion treated (OS 16.2mths), 35pts had 2-5 lesions treated (OS 9.7mths), 19 pts had ≥6 lesions (OS 19.2mths). Whilst the number of lesions treated did not correlate with OS (r=-0.095, p = 0.37) a larger volume of tumour treated (>10cm3) was associated with worse survival (r=-0.253, p = 0.01). At the time of SRS 17pts had no other systemic disease (OS 13.7mths). When present, control of systemic disease outside the brain was associated with improved OS (36 pts stable systemic disease OS = 20mths, 32 pts progressive systemic disease (PSD) OS = 9.7mths; p = 0.0013). 49 pts had known disease status at death, 17 had PSD, 16 had progressive CNS disease (PCD), 13 had PSD + PCD and 3 had no progression.
Conclusions
Age, receptor status, control of systemic disease, total tumour volume treated, but not the number of lesions appears to influence survival following SRS treatment of BM in BC. Our results are consistent with other series with worse outcomes seen in older patients and those with TN cancers. In addition to treating BM, control of systemic disease outside the brain remains important in prolonging survival.
Clinical trial identification
Legal entity responsible for the study
Jeremy Braybrooke.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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