PCI in High Risk Advanced Breast Cancer Patients

Abstract

Background: A high incidence of brain metastases has been conveyed in patients with triple-negative and her 2-positive breast cancer receiving trastuzumab therapy. The rationale for prophylactic cranial irradiation is to regulate or eliminate unnoticeable micro-metastases without making unwanted harm. Methods: This prospective study investigated the role of prophylactic cranial irradiation for lowering the frequency of brain metastases for patients who had triple-negative and her2-positive advanced extra-cranial metastatic breast cancer including 48 succeeding patients, with this disease scenario were collected in this study & were categorized into 2 arms over 3 years period: The first arm consisted of 24 patients who did not receive PCI. The second group included 24 patients who received PCI 25 Gray/10 fractions over 2 weeks carried 4 weeks after completion of chemotherapy with or without trastuzumab while hormone therapy is continuous for hormone-positive patients. All patients were primarily evaluated by brain CT scan with contrast or MRI which was part of the neurological assessment included before PCI then every 3 months in the first year, then every 6 months thereafter. Neuro-cognitive Functions (NCF) were estimated in both arms before and then 6 months and 1 year after PCI using Mini-Mental State Exam (MMSE). Health-related quality of life was assessed before and then 1 month and 3 months after PCI using Functional Assessment of Cancer Therapy-Brain (FACT-Br). Results , only four (16.6%) patients developed symptomatic brain metastases in the treatment arm compared to nine (37.5%) patients in the control arm, the median brain metastasis-free survival duration in the PCI arm was 22 months with a 95% CI (18.37-25.62) compared with 16 months with a 95% CI (13.78-18.21) with p = 0.011, figure (1). A brain metastases hazard ratio = 0.398, 95% CI (0.187.0.844) is significantly reduced by 60% in the PCI patients set when compared to no PCI arm at any given time over 30 months with p-value (0.016). All patients died due to progressive breast cancer. There were no death due to treatment. Three of the 24 patients experienced grade 3/4 toxicity (two grade 3 nausea and vomiting, one grade 4 nausea and vomiting). Grade 1 to 4 fatigue occurred in majority of the fifteen (62.5%) treated patients, but only in 3 (12.5%) grade 3 and 4 patients. Hair loss was virtually common as a consequence of chemotherapy, so no more alopecia was observed during PCI. Neurocognitive function in both groups was equal, without statistical differences between the MMSE scores between the two study arms (p=0.137). Most of the MMSE scores declined at a 6-month evaluation in the PCI group with a significant difference at a P value of 0.001, but resumed to the baseline value in the one-year evaluation without statistical difference between the two arms, P = 0.679. The initial levels of evaluation of the quality of life of the respondents in both groups were comparable, without statistical differences, P = 1.000. In the PCI group, most of the scores (FACT-Br) were reduced at the 1-month evaluation compared to no PCI group with a significant difference at a P value of 0.050, but returned almost to baseline at the 3-month evaluation without statistical differences between the two groups, (P=0.162). Conclusions: PCI was linked with accepted toxicities & give rise to lower frequency of brain secondary metastasis with prolonged median brain metastasis-free survival duration. Whether, this result may be interpreted into satisfactory therapeutic improvement necessite an additional assessment.