ROLE OF SURGERY IN THE TREATMENT OF BRAIN METASTASES IN PATIENTS WITHBREAST-CANCER

Background: Patients whose brain metastases from breast cancer are tre ated nonsurgically have a median length of survival ranging from 2.5 t o 7.5 months, and a median time to recurrence ranging from 2 to 5 mont hs. Patients treated with radiotherapy have a median length of surviva l ranging from 3 to 4 months. Those treated with chemotherapy have a m edian length of survival ranging from 5.5 to 7.5 months. Methods: We c onducted a retrospective analysis on 63 patients treated over a 10-yea r period. Only patients who underwent surgery for nonrecurrent brain m etastases were studied. Sixty-one patients (97%) underwent surgery wit hin 2 weeks of diagnosis of the brain metastases. Results: The median length of survival was 16 months (95% confidence interval [CI] 11 to 2 2 months), and the 5-year survival rate was 17% (CI 9% to 29%). Brain metastases recurred in 27 patients at a median interval of 15 months ( CI 12 to 24 months). Eleven patients had local recurrence, 10 had dist al recurrence, and seven developed leptomeningeal disease. Significant prognosticators of length of survival were age (p = 0.011), menopause status (p = 0.10), postoperative radiotherapy (p = 0.054), preoperati ve neurologic status (p = 0.011), and preoperative systemic disease st atus (p = 0.0003). Systemic disease status had a significant effect on the length of survival but not on the time to recurrence.