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Central Nervous System Failure in Korean Breast Cancer Patients with HER2-Enriched Subtype: Korean Radiation Oncology Group 16-15 Multicenter Retrospective Study

Title
Central Nervous System Failure in Korean Breast Cancer Patients with HER2-Enriched Subtype: Korean Radiation Oncology Group 16-15 Multicenter Retrospective Study
Authors
Kim, KyuboShin, Kyung HwanKim, Jin HoChoi, Doo HoPark, WonKim, Yong BaeKim, Hyun JuKim, Jin HeePark, HyeliLee, Sun YoungKim, JiyoungOh, Do HoonKim, In Ah
Ewha Authors
김규보
SCOPUS Author ID
김규보scopus
Issue Date
2019
Journal Title
JOURNAL OF BREAST CANCER
ISSN
1738-6756JCR Link

2092-9900JCR Link
Citation
JOURNAL OF BREAST CANCER vol. 22, no. 1, pp. 120 - 130
Keywords
Breast neoplasmsCentral nervous system neoplasmsERBB2 proteinRadiotherapyTrastuzumab
Publisher
KOREAN BREAST CANCER SOC
Indexed
SCIE; SCOPUS; KCI WOS
Document Type
Article
Abstract
Purpose: The purpose of this study was to evaluate the risk of central nervous system (CNS) failure in Korean patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer treated with surgery followed by postoperative radiotherapy (RT). Methods: A total of 749 patients from eight institutions were enrolled in this study. All of them underwent surgery followed by postoperative RT from 2003 to 2011; 246 (32.8%) received neoadjuvant chemotherapy and 649 (81.7%) received adjuvant chemotherapy. Adjuvant trastuzumab was administered to 386 patients (48.6%). Results: The median follow-up duration was 84 (range, 8-171) months. The 7-year disease-free and overall survival rates were 79.0% and 84.2%, respectively. On multivariate analysis, mastectomy, nodal involvement, and presence of lymphatic invasion were correlated with poor overall survival (p = 0.004, 0.022, and 0.011, respectively), whereas T stage and lymphatic invasion were associated with disease-free survival (p = 0.018 and 0.005, respectively). Regarding CNS failures, 30 brain metastases, 2 leptomeningeal metastases, and 8 brain and leptomeningeal metastases were noted. The 7-year CNS relapse-free survival rates in patients receiving and not receiving trastuzumab were 91.2% and 96.9%, respectively (p = 0.005). On multivariate analysis, the administration of adjuvant trastuzumab was the only prognostic factor in predicting a higher CNS failure rate (hazard ratio, 2.260; 95% confidence interval, 1.076-4.746; p = 0.031). Conclusion: Adjuvant trastuzumab was associated with higher CNS failure rate in Korean patients with HER2-enriched breast cancer. Close monitoring and reasonable approaches such as CNS penetrating HER2 blockades combined with the current standard therapy could contribute to improving intracranial tumor control and quality of life in patients with CNS metastasis from HER2-enriched breast cancer.
DOI
10.4048/jbc.2019.22.e1
Appears in Collections:
의과대학 > 의학과 > Journal papers
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