SURGICAL-TREATMENT OF 70 PATIENTS WITH BRAIN METASTASES FROM BREAST-CARCINOMA

BACKGROUND. Brain metastases are diagnosed in 15% of patients with met astatic breast carcinoma. Most patients are treated with whole-brain r adiotherapy (WBRT) and/or chemotherapy. The information on surgical re sults is sparse. METHODS. Among 709 patients with tumors metastatic to the brain who underwent craniotomy at Memorial Hospital, New York, Ne w York, between January 1974 and December 1993, 70 (10%) had a primary breast carcinoma. Their treatment outcomes were analyzed retrospectiv ely. RESULTS. The median age at diagnosis of primary breast carcinoma and brain metastasis was 46 and 50 years, respectively. All but two pa tients had metachronous diagnoses of breast carcinoma and brain metast asis. The median interval between both diagnoses in this subgroup was 28 months. In all 70 patients, the overall median survival was 54 mont hs after diagnosis of the primary breast tumor and 16.2 months after d iagnosis of the brain tumor. Only 5 patients (7%) were alive at last f ollow-up. The overall median survival after brain surgery was 14 month s. Four patients died within 30 days of craniotomy. Twelve patients ha d a solitary cerebellar metastasis and 16 had multiple metastases; the ir median survival was 10.9 months and 14.8 months, respectively. Ther e was no statistical difference in survival for patients who had singl e or multiple lesions. The median survival of 22 patients with positiv e hormonal receptor (estrogen receptor [ER] or progesterone receptor [ PR]) was significantly longer than the median survival of 20 patients with negative ER/PR (21.9 vs. 12.5 months, P < 0.05). For 35 patients (50%) who had brain lesions greater than or equal to 4 cm, the median survival was 11 months, compared with 16.3 months for patients with sm aller lesions (P = 0.16, not significant [NS]). Patients age less than or equal to 50 years versus >50 years had survival of 17.3 and 11.1 m onths, respectively (P = NS). Neurologic deficit prior to craniotomy s hortened survival for 24 patients to 11.5 months, compared with 17.4 m onths for patients without deficit (P = NS). Fifteen patients experien ced failure with WBRT prior to undergoing craniotomy, and their median survival was shorter than for those who underwent craniotomy as the i nitial treatment (6.3 vs. 15.8 months, P < 0.03). However, their survi val after diagnosis of brain metastasis was not significantly differen t (19.2 vs. 16.1). Forty-seven patients received WBRT postoperatively, and 9 patients did not receive adjuvant radiation therapy. Subsequent relapse in the brain was diagnosed in 27 patients, and 8 of them unde rwent reresection. One-year, 2-year, 3-year, and 5-year survival rates were 53%, 25.7%, 18.6%, and 7%, respectively. In multivariate analysi s, the adjuvant WBRT after craniotomy and the absence of meningeal car cinomatosis were the only significant predictive variables for longer survival. CONCLUSIONS. In a subset of selected patients, craniotomy fo llowed by WBRT can positively impact survival. (C) 1997 American Cance r Society.