Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer

Bing Sun, Zhou Huang, Shikai Wu, Lijuan Ding, Ge Shen, Lei Cha, Junliang Wang, Santai Song, Bing Sun, Zhou Huang, Shikai Wu, Lijuan Ding, Ge Shen, Lei Cha, Junliang Wang, Santai Song

Abstract

Purpose: Brain metastasis (BM) with a cystic component from breast cancer is rare and largely uncharacterized. The purpose of this study was to identify the characteristics of cystic BM in a large cohort of breast cancer patients.

Results: A total of 35 eligible patients with cystic BM and 255 patients with solid BM were analyzed. Three factors were significantly associated with an increased probability of developing cystic lesions: age at diagnosis ≤ 40 years, age at BM ≤ 45 years, and poor histological grade (p < 0.05). Patients with cystic metastasis were also characterized by a larger metastasis volume, a shorter progression-free survival (PFS) following their first treatment for BM, and poor overall survival after BM (p < 0.05). Multivariate analysis further demonstrated that local control of cystic BM was only potentially achieved for HER2-negative primary tumors (p = 0.084).

Methods: Breast cancer patients with parenchymal BM were reviewed from consecutive cases treated at our institution. Cystic BM was defined when the volume of a cystic lesion was greater than 50% of the aggregated volume of all lesions present. Clinicopathologic and radiographic variables were correlated with development of cystic lesions and with prognosis of cystic BM.

Conclusions: This study shows that cystic BM from breast cancer, a special morphological type of BM, had worse prognosis than the more commonly observed solid BM. Younger age and low tumor grade were associated with the development of cystic lesions. Further comprehensive research and management of cystic BM are warranted to improve its poor prognosis.

Keywords: brain metastases; breast cancer; cyst; stereotactic radiosurgery; whole-brain radiotherapy.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare that they have no conflicts of interests.

Figures

Figure 1. Cumulative overall survival (OS) after…
Figure 1. Cumulative overall survival (OS) after diagnosis of cystic versus solid brain metastases
Figure 2. Typical characteristics of cystic versus…
Figure 2. Typical characteristics of cystic versus solid brain metastases observed in MRI images
Axial T1-weighted (A) and T2-weighted (B) post-contrast MRI of right frontal and parietal cystic metastases with appearance of hypointensity A. and hyperintensity B. and surrounding edema. C. Sagittal T1-weighted post-contrast imaging. D. Axial T1-weighted MRI of solid lesions.

References

    1. Ranjan T, Abrey LE. Current management of metastatic brain disease. Neurotherapeutics. 2009;6:598–603.
    1. Marko NF, Xu Z, Gao T, Kattan MW, Weil RJ. Predicting survival in women with breast cancer and brain metastasis: a nomogram outperforms current survival prediction models. Cancer. 2012;118:3749–3757.
    1. Sun B, Huang Z, Wu S, Shen G, Cha L, Meng X, Ding L, Wang J, Song S. Incidence and relapse risk of intracranial metastases within the perihippocampal region in 314 patients with breast cancer. Radiother Oncol. 2016;118:181–186.
    1. Shaffrey ME, Mut M, Asher AL, Burri SH, Chahlavi A, Chang SM, Farace E, Fiveash JB, Lang FF, Lopes MB, Markert JM, Schiff D, Siomin V, Tatter SB, Vogelbaum MA. Brain metastases. Curr Probl Surg. 2004;41:665–741.
    1. Niwinska A, Murawska M, Pogoda K. Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT) Ann Oncol. 2010;21:942–948.
    1. Lin NU, Amiri-Kordestani L, Palmieri D, Liewehr DJ, Steeg PS. CNS metastases in breast cancer: old challenge, new frontiers. Clin Cancer Res. 2013;19:6404–6418.
    1. De Ieso PB, Schick U, Rosenfelder N, Mohammed K, Ross GM. Breast cancer brain metastases - A 12 year review of treatment outcomes. Breast. 2015;24:426–433.
    1. Ebinu JO, Lwu S, Monsalves E, Arayee M, Chung C, Laperriere NJ, Kulkarni AV, Goetz P, Zadeh G. Gamma knife radiosurgery for the treatment of cystic cerebral metastases. Int J Radiat Oncol Biol Phys. 2013;85:667–671.
    1. Jung TY, Kim IY, Jung S, Jang WY, Moon KS, Park SJ, Lim SH. Alternative treatment of stereotactic cyst aspiration and radiosurgery for cystic brain metastases. Stereotact Funct Neurosurg. 2014;92:234–241.
    1. Higuchi F, Kawamoto S, Abe Y, Kim P, Ueki K. Effectiveness of a 1-day aspiration plus Gamma Knife surgery procedure for metastatic brain tumor with a cystic component. J Neurosurg. 2012;117:17–22.
    1. Park WH, Jang IS, Kim CJ, Kwon do H. Gamma knife radiosurgery after stereotactic aspiration for large cystic brain metastases. J Korean Neurosurg Soc. 2009;46:360–364.
    1. Franzin A, Vimercati A, Picozzi P, Serra C, Snider S, Gioia L, Ferrari da Passano C, Bolognesi A, Giovanelli M. Stereotactic drainage and Gamma Knife radiosurgery of cystic brain metastasis. J Neurosurg. 2008;109:259–267.
    1. Kim M, Cheok S, Chung LK, Ung N, Thill K, Voth B, Kwon do H, Kim JH, Kim CJ, Tenn S, Lee P, Yang I. Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration. Brain Tumor Res Treat. 2015;3:1–7.
    1. Yamanaka Y, Shuto T, Kato Y, Okada T, Inomori S, Fujino H, Nagano H. Ommaya reservoir placement followed by Gamma Knife surgery for large cystic metastatic brain tumors. J Neurosurg. 2006;105:79–81.
    1. Lee SR, Oh JY, Kim SH. Gamma Knife radiosurgery for cystic brain metastases. Br J Neurosurg. 2016;30:43–48.
    1. Hayashi H, Okamoto I, Tanizaki J, Tanaka K, Okuda T, Kato A, Nishimura Y, Nakagawa K. Cystic brain metastasis in non-small-cell lung cancer with ALK rearrangement. J Clin Oncol. 2014;32:e122–124.
    1. Narayanan V, Honce MJ, Mehrotra S, Camidge DR. Cystic Brain Metastases Occurring in Anaplastic Lymphoma Kinase Gene Rearranged Non-Small-Cell Lung Cancer Patients Receiving Crizotinib. Clin Lung Cancer. 2016;17:85–90.
    1. Costa R, Costa RB, Bacchi C, Sarinho F. Adenocarcinoma of the lung presenting with atypical cystic brain lesions. BMJ case reports. 2014. p. 2014.
    1. Saraceni C, Li PM, Gainor JF, Stopyra GA, Friedman EL. Cystic Brain Metastases in NSCLC Harboring the EML4-ALK Translocation after Treatment with Crizotinib. J Thorac Oncol. 2015;10:1116–1117.
    1. Yeh RH, Yu JC, Chu CH, Ho CL, Kao HW, Liao GS, Chen HW, Kao WY, Yu CP, Chao TY, Dai MS. Distinct MR Imaging Features of Triple-Negative Breast Cancer with Brain Metastasis. J Neuroimaging. 2015;25:474–481.
    1. Lohle PN, Wurzer HA, Seelen PJ, Kingma LM, Go KG. The pathogenesis of cysts accompanying intra-axial primary and metastatic tumors of the central nervous system. J Neurooncol. 1998;40:277–285.
    1. Lohle PN, Wurzer HA, Seelen PJ, Kingma LM, Go KG. Analysis of fluid in cysts accompanying various primary and metastatic brain tumours: proteins, lactate and pH. Acta Neurochir (Wien) 1998;140:14–19.
    1. Neagu MR, Gill CM, Batchelor TT, Brastianos PK. Genomic profiling of brain metastases: current knowledge and new frontiers. Chin Clin Oncol. 2015;4:22.
    1. Schemper M, Smith TL. A note on quantifying follow-up in studies of failure time. Control Clin Trials. 1996;17:343–346.

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