Breast Cancer Brain Metastases: A Neurosurgical Point of View From a Single-Center Experience

Abstract

Background: Brain metastases represent an important factor in breast cancer morbidity and mortality. Although various therapeutic options improved these patients' outcomes, the incidence of this disease is still rising. Several molecular subtypes of breast cancer have been studied, and human epidermal growth factor receptor 2 (HER2) positive and triple-negative breast cancer (TNBC) are more frequently associated with brain metastases. Therefore, anti-HER2 agents have been developed and studied, and they have shown promising results. Nevertheless, in patients with breast cancer brain metastases and acute neurological aggravation, neurosurgery is the primary option and the only one that can immediately reverse the symptoms. In the long run, a multimodal approach involving neurosurgical intervention can positively impact the prognosis.

Material and methods: Patients with a confirmed diagnosis of brain metastases from breast cancer (BMBC) between January 2013 and December 2023 were retrospectively reviewed. All patients were newly diagnosed and treated in the 3rd Neurosurgical Department at the Clinical Emergency Hospital, "Bagdasar-Arseni" in Bucharest, Romania. Statistical analyses were carried out and interpreted accordingly.

Results: The study analyzed 62 patients with BMBC. The median age at diagnosis was 57.19 years, and the most frequently encountered symptoms were represented by headaches, raised intracranial pressure syndrome, and motor deficits. More than 80% of the patients had a Karnofsky Performance Status (KPS) between 80 and 100, and the most associated comorbidities were cardiovascular and type 2 diabetes mellitus. A total of 88.70% of the patients had a single brain metastasis, and the most common localizations were the posterior fossa/cerebellum and frontal lobe. Gross-total resection was possible in 79.03% of the cases, while complications were recorded in 8.06%. Better survival rates were registered in patients of younger ages, with higher KPS, single BM, and smaller tumoral volumes, treated by gross-total resection and by a multimodal approach.

Conclusions: Notwithstanding significant advancements in the field of breast cancer, the prognosis of patients with brain metastases remains poor. However, a multimodal approach can prolong survival rates and improve outcomes, while in patients with acute clinical manifestations, neurosurgery remains the only immediate option to reverse the symptoms.

Keywords: brain metastases; breast cancer; multimodal approach; neurosurgery; outcomes.

Figure 1. Tumoral volumes of BMBC distributed by age groups

The image highlights the presence of the largest tumoral volumes in patients from the 50-59 and 60-69 age groups, as well as the smallest tumoral volumes in patients over 80 years old and from the 30-39 years old group. BMBC: brain metastases from breast cancer The image was created by the author of this article.

Figure 2. The distribution of symptoms in the study group concerning age groups

1 – Headache; 2 – RIPS; 3 – Motor deficits; 4 – Seizures; 5 – Altered mental status; 6 – Vertigo; 7 – Visual disturbances; 8 – Nystagmus; 9 – Hydrocephalus; 10 – Aphasia/Dysphasia; 11 – Dysarthria; 12 – Dysphagia; 13 – Facial nerve paralysis; 14 – Gait disturbances; 15 – Frontal lobe syndrome; 16 – Amnesia; 17 – Trigeminal neuralgia; 18 – Hypoacusis; 19 – Dysmetria; 20 – Ataxia; 21 – Hypothalamic dysfunction RIPS: raised intracranial pressure syndrome The image was created by the author of this article.

Figure 3. Kaplan-Meier plot describing the survival rate according to age groups

The image was created by the author of this article.

Figure 4. Kaplan-Meier plot describing survival rates according to geographical localization

The image was created by the author of this article.

Figure 5. Kaplan-Meier plot describing survival rates based on KPS at admission

KPS: Karnofsky Performance Status The image was created by the author of this article.

Figure 6. Kaplan-Meier plot describing survival rates in patients with different tumoral volumes

The image was created by the author of this article.

Figure 7. Kaplan-Meier plot describing survival rates in patients with different tumoral resection grades

GTR: gross-total resection; STR: subtotal resection The image was created by the author of this article.

Figure 8. Kaplan-Meier plot describing survival rates in patients with single or multiple cerebral BMBC

BMBC: brain metastases from breast cancer The image was created by the author of this article.

Figure 9. Kaplan-Meier plot describing survival rates based on different therapeutic approaches in the study group

The image was created by the author of this article.