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Novel prognostic classification predicts overall survival of patients receiving salvage whole-brain radiotherapy for recurrent brain metastasis from breast cancer: A recursive partitioning analysis (KROG 16-12)

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Kim, Jae Sik; Kim, Kyubo; Jung, Wonguen; Shin, Kyung Hwan; Im, Seock-Ah; Kim, Yong Bae; Chang, Jee Suk; Choi, Doo Ho; Kim, Haeyoung; Park, Yeon Hee; Kim, Dae Yong; Kim, Tae Hyun; Kwon, Jeanny; Kang, Ki Mun; Chung, Woong-Ki; Kim, Kyung Su; Kim, In Ah

Issue Date
Churchill Livingstone
Breast, Vol.60, pp.272-278
Background: To investigate outcomes of salvage whole-brain radiotherapy (WBRT) for recurrent brain metastases (BM) from breast cancer (BC), to identify prognostic factors of overall survival (OS), and to propose a novel prognostic classification for OS in these patients. Materials and methods: We identified 54 patients who had received salvage WBRT as the second brain-focused treatment for recurrent BM from BC (2000-2014). The median follow-up duration was 4.9 months. A recursive partitioning analysis (RPA) was conducted to develop a model to predict OS at the time of salvage WBRT. Results: The median OS was 6.8 months. OS according to BC-specific graded prognostic assessment (breast-GPA), modified breast-GPA, and updated breast-GPA did not represent our cohort. In the multivariate analysis, a long time before salvage WBRT (>= 16 months), control of primary BC or extracranial metastases, systemic treatment after salvage WBRT, and administration of a biologically effective dose for an alpha/beta of 10 Gy (BED10) of salvage WBRT >37.5 Gy showed superior OS. We proposed three RPA classes based on the control of both primary BC and extracranial metastasis and BED10 of salvage WBRT: class I, class II, and class III. In this model, patients with class I experienced the best OS (34.6 months; class II, 5.0 months; class III, 2.4 months; P < 0.001). Conclusions: In our RPA classification according to the control of both primary BC and extracranial metastasis and the dose of salvage WBRT, significant differences in OS were observed. The subsequent use of a systemic treatment showed better OS. (C) 2021 The Authors. Published by Elsevier Ltd.
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  • College of Medicine
  • Department of Medicine
Research Area Clinical Medicine


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