Rosenblum-Mahaley Clinical Research Award: The Genetic Profile Affects Survival in Breast Cancer Brain Metastasis Patients Treated by Stereotactic Radiosurgery

Sunday, May 5, 2024

2:37 PM – 2:42 PM CT

Location: S403ab

Presenting Author(s)

David J. Puccio, B.S. (he/him/his)

Medical Student
University of Pittsburgh Medical Center; Albany Medical College
Gibsonia, PA, US

Co-Author(s)

Hansen Deng, MD

Resident Physician
Department of Neurological Surgery, University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Constantinos G. Hadjipanayis, MD, PhD

Professor of Neurological Surgery
University of Pittsburgh Medical Center
New York, New York, United States
SJ

Shalini G. Jose, MS

Medical Student
University of Pittsburgh Medical Center, United States
LL

L. Dade Lunsford, MD

Professor of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
AN

Ajay Niranjan, MD, MBA

Professor of Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Zhishuo Wei, MS

Medical Student
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Disclosure(s):

David Puccio, BS: No financial relationships to disclose

Introduction: Although breast cancer brain metastasis (BCBM) is the second most common form of brain metastases treated by stereotactic radiosurgery (SRS), little is known about the effect of genetic profiles on outcomes.

Methods: We studied 237 patients who underwent SRS between 2010 and 2020. We identified 152 patients who were hormone (estrogen or progesterone) receptor (HR) positive, 60 patients who were HER2+ (25.32%), and 25 patients who had triple negative breast cancer (TNBC) (10.55%). The median age at SRS was 59 (range: 31 – 91) years. Forty-three patients (18.14%) underwent pre-SRS surgical resection, and 92 patients (38.82%) underwent pre-SRS whole brain radiation therapy (WBRT). Overall, 2,178 brain metastases were treated, with a median of 4 (range: 1 – 75) per patient. The median cumulative tumor treatment volume per patient was 5.33 cm3 (range: 0.022 – 57.4). The median margin dose was 18 Gy (range: 10 – 20).

Results: The median overall survival (OS) was 15 months (range: 0 – 123). The median OS for HR+, HER2+, and TNBC were 15 months, 18 months, and 9 months. TNBC patients had significantly lower OS rates than HR+ (p = 0.0018,) and HER2+ patients (p = 0.0024). Twenty-nine patients (12.23%) had local tumor progression (median, 10 months; range: 1– 91). TNBC patient local tumor control rates (7 patients, 28.00%) were significantly lower than HR+ (15 patients, 9.87%) (p = 0.0002) and HER2+ (7 patients, 11.67%) (p = 0.0002). One hundred six patients (44.73%) had distant tumor progression (median, 7 months; range: 1 – 63). No significant difference in distant tumor progression was found across genetic profiles.

Conclusion : We found significant differences in local tumor response to SRS across tumors with different genetic profiles. SRS remains an important component of the multimodality management of BCBM as systemic treatment options evolve.