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Multicenter Study
. 2024 Sep;169(2):379-390.
doi: 10.1007/s11060-024-04728-w. Epub 2024 Jun 3.

Role of microsurgical tumor burden reduction in patients with breast cancer brain metastases considering molecular subtypes: a two-center volumetric survival analysis

Jacopo Bellomo  1 , Anna Maria Zeitlberger  2 , Luis Padevit  1 , Vittorio Stumpo  1 , Meltem Gönel  1 , Jorn Fierstra  1 , Nathalie Nierobisch  3 , Regina Reimann  4 , Isabell Witzel  5 , Michael Weller  6 , Emilie Le Rhun  1   6 , Oliver Bozinov  2 , Luca Regli  1 , Marian Christoph Neidert  2 , Carlo Serra  1 , Stefanos Voglis  7
Affiliations
Multicenter Study

Role of microsurgical tumor burden reduction in patients with breast cancer brain metastases considering molecular subtypes: a two-center volumetric survival analysis

Jacopo Bellomo et al. J Neurooncol. 2024 Sep.

Abstract

Background: Advancements in metastatic breast cancer (BC) treatment have enhanced overall survival (OS), leading to increased rates of brain metastases (BM). This study analyzes the association between microsurgical tumor reduction and OS in patients with BCBM, considering tumor molecular subtypes and perioperative treatment approaches.

Methods: Retrospective analysis of surgically treated patients with BCBM from two tertiary brain tumor Swiss centers. The association of extent of resection (EOR), gross-total resection (GTR) achievement, and postoperative residual tumor volume (RV) with OS and intracranial progression-free survival (IC-PFS) was evaluated using Cox proportional hazard model.

Results: 101 patients were included in the final analysis, most patients (38%) exhibited HER2-/HR + BC molecular subtype, followed by HER2 + /HR + (25%), HER2-/HR- (21%), and HER2 + /HR- subtypes (13%). The majority received postoperative systemic treatment (75%) and radiotherapy (84%). Median OS and intracranial PFS were 22 and 8 months, respectively. The mean pre-surgery intracranial tumor volume was 26 cm3, reduced to 3 cm3 post-surgery. EOR, GTR achievement and RV were not significantly associated with OS or IC-PFS, but higher EOR and lower RV correlated with extended OS in patients without extracranial metastases. HER2-positive tumor status was associated with longer OS, extracranial metastases at BM diagnosis and symptomatic lesions with shorter OS and IC-PFS.

Conclusions: Our study found that BC molecular subtypes, extracranial disease status, and BM-related symptoms were associated with OS in surgically treated patients with BCBM. Additionally, while extensive resection to minimize residual tumor volume did not significantly affect OS across the entire cohort, it appeared beneficial for patients without extracranial metastases.

Keywords: Brain metastasis; Breast cancer; Extent of resection; Overall survival; Residual tumor; Targeted therapy.

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Conflict of interest statement

ELR: has received a research grant from BMS, and honoraria for advisory board participation from Astra Zeneca, Bayer, Biiodexa, Janssen, Leo Pharma, Pfizer, Pierre Fabre, Seagen and Servier.

MW has received research grants from Novartis, Quercis and Versameb, and honoraria for lectures or advisory board participation or consulting from Anheart, Bayer, Curevac, Medac, Neurosense, Novartis, Novocure, Orbus, Pfizer, Philogen, Roche and Servier.

Figures

Fig. 1
Fig. 1
Molecular subtypes and postoperative therapies per patient. This plot indicates the molecular subtype per patient and the corresponding local or systemic therapies which the patient underwent after resection of the BCBM. HER2, human epidermal growth factor receptor-2; HR, hormone receptor; ICI, immune checkpoint inhibitor; RT, radiotherapy
Fig. 2
Fig. 2
Overall survival and intracranial progression-free survival according to the achievement of GTR. Kaplan–Meier curve with log-rank statistic of patients stratified by the achievement of GTR, defined as EOR = 100%. A Overall survival, B intracranial progression-free survival. Time is reported in months from surgery; Follow-up time is clipped at 9 years for better readability. EOR, extent of resection; GTR, gross-total resection
See this image and copyright information in PMC

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