Modern Systemic therapies with Radiosurgery for Brain Metastases from Breast Cancer

IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of the National Medical Association Pub Date : 2024-08-01 DOI:10.1016/j.jnma.2024.07.102
Andjie Jeudy BS, David J. Crompton, Danushka S. Seneviratne, Pooja Advani, Jennifer Peterson, William C. Fox, Sanjeet Grewal, Laura Vallow, Daniel M. Trifiletti
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Abstract

Objective

Stereotactic radiosurgery is an established treatment for breast cancer brain metastases. However, there is limited data regarding the clinical outcomes of SRS when delivered with targeted systemic therapies. Our aim was to assess the clinical outcomes and toxicities of patients receiving modern systemic therapy concurrently with SRS in comparison to patients undergoing traditional cytotoxic chemotherapy and SRS.

Methods

Through this IRB-approved retrospective analysis, we collected the clinical outcomes of 43 patients with brain metastases from breast cancer treated with SRS in combination with modern targeted systemic therapies (delivered within 4 weeks of SRS).

Results

A total of 235 brain metastases were treated with single fraction SRS in combination with systemic therapy. Of the 235 tumors, 49 were treated with concurrent cytotoxic systemic therapy, 60 with antibody or endocrine, 41 with immunotherapy combination, 56 were not treated with concurrent systemic therapy, and 56 received other systemic therapy. In comparison to patients receiving concurrent cytotoxic chemotherapy and SRS, those receiving antibody/endocrine therapy with SRS and those receiving no systemic therapy had significantly higher rates of local treatment failure (p=0.005). Patients receiving immunotherapy concurrently with SRS had similar rates of local treatment failure compared to those undergoing cytotoxic chemotherapy (p=0.47). We found no association between the type of systemic therapy delivered with SRS and elsewhere brain failure, or radionecrosis (all p>0.2).

Conclusion

Delivery of no therapy with SRS or the delivery of antibody/endocrine therapy concurrently with SRS were both associated with significantly higher rates of local treatment failure.

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放射外科治疗乳腺癌脑转移瘤的现代全身疗法
目的立体定向放射外科是治疗乳腺癌脑转移的一种成熟疗法。然而,有关 SRS 与靶向系统疗法同时使用时的临床疗效的数据却很有限。我们的目的是评估在接受 SRS 的同时接受现代全身疗法的患者与接受传统细胞毒性化疗和 SRS 的患者的临床疗效和毒性反应。方法通过这项经 IRB 批准的回顾性分析,我们收集了 43 例接受 SRS 结合现代靶向全身疗法(在 SRS 后 4 周内进行)治疗的乳腺癌脑转移患者的临床疗效。在这235例肿瘤患者中,49例同时接受了细胞毒系统治疗,60例接受了抗体或内分泌治疗,41例接受了免疫疗法联合治疗,56例未同时接受系统治疗,56例接受了其他系统治疗。与同时接受细胞毒化疗和SRS的患者相比,接受抗体/内分泌治疗和SRS的患者以及未接受系统治疗的患者的局部治疗失败率明显更高(P=0.005)。与接受细胞毒化疗的患者相比,同时接受免疫疗法和SRS的患者的局部治疗失败率相似(p=0.47)。我们发现,SRS同时进行的系统治疗类型与其他部位的脑衰竭或放射性坏死之间没有关联(均为p>0.2)。结论SRS同时进行无治疗或SRS同时进行抗体/内分泌治疗均与局部治疗失败率显著升高有关。
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来源期刊
CiteScore
4.80
自引率
3.00%
发文量
139
审稿时长
98 days
期刊介绍: Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.
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