Long-term survival after brain metastases in breast cancer

Abstract

Purpose: Long-term survival after whole brain irradiation for cerebral metastases is rare. In order to identify a possible subgroup of patients with a prolonged survival time, a retrospective analysis was carried out.

Patients and methods: From 1977 to 1991, 197 patients with singular (51%) or multiple (49%) brain metastases were treated with whole brain irradiation (30 to 36 Gy, 2 to 3 Gy daily fractions, an additional boost of 8 to 20 Gy in 8%) or resection of a singular metastasis and postoperative irradiation (36 patients, 30 to 36 Gy, 2 to 3 Gy fractions whole brain irradiation, boost of 8 to 20 Gy in 31%).

Results: Fifty-seven patients (24%) had metastases of breast cancer. In this group, 3 of 8 patients with combined treatment of a singular metastasis survived more than 5 years from the onset of brain irradiation, compared to 1 of 8 patients with non-small-cell lung cancer and none of 14 patients with unknown primaries. In the group which was treated with irradiation only, breast cancer patients with an interval of more than 5 years between primary and brain metastasis had the best prognosis with 4 of 12 patients surviving more than 3 years, but less than 5 years.

Conclusion: These results demonstrate that long-term survival is not only possible in the known cases of solitary brain metastasis in non-small-cell lung cancer but also in breast cancer, combined treatment provided.