Chirurgische Behandlung von multiplen Hirnmetastasen bei Mammacarcinom: klinische Merkmale und Faktoren, die das postoperative Überleben beeinflussen

Objective

Breast cancer (BC) is one of the most common primary tumor entities developing brain metastases (BM) in the course of disease. Multiple BM are associated with poorer prognosis, but different surgical, radio- and systemic therapy concepts improved survival. We aimed to analyze the baseline patterns of patients with single vs multiple BCBM and to compare their prognosis after BM surgery.

Methods

All metachronous metastasized female patients with resected (singular and multiple) BCBM in our institution between 2008 and 2019 were included. We compared various clinical, radiologic, and histopathologic parameters of BC patients with multiple and singular BM. Postoperative survival was analyzed using univariate and multivariate Cox regression models.

Results

We included 93 patients (median age of 60.0 years at BM diagnosis), where 30 patients presented with multiple (median age of 58.5 years) and 63 patients with singular BM (median age of 60.3 years). BC individuals with multiple BM were more frequently treated for infratentorial BM (aOR 3.35, 95% CI 1.03-10.83, p=0.044), showed positive HER2 receptor status of BC (aOR 3.93, 95% CI 1.23-12.53, p=0.021) and the presence of hepatic metastases (aOR 5.86, 95% CI 1.34-25.61, p=0.019) than the counterparts with single BM. There was no significant difference in postoperative survival between individuals with multiple (median: 12.5 months) and singular BM (17.0 months, p=0.186). Moreover, the adjuvant radiotherapy improved survival after BM resection, showing more prominent effect in cases of multiple BM (HR 0.09, 95% CI 0.02-0.50, p=0.006).

Conclusion

BC patients with multiple BM show remarkable postoperative survival, particularly if combined with adjuvant radiotherapy. Our data justify the surgical treatment of multiple BCBM in patients with appropriate clinical condition and feasable location of BM.