<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2019-0020_s_005_w2aab3b7b7b1b6b1aab1c18b1Aa"><h3>Background</h3><p>Previous survival scores for breast cancer patients with cerebral metastases were developed in cohorts receiving heterogeneous treatments, which could have introduced selection biases. A new instrument (WBRT-30-BC) was created from 170 patients receiving whole-brain radiotherapy (WBRT) alone with 30 Gy in 10 fractions.</p></sec><sec id="j_raon-2019-0020_s_006_w2aab3b7b7b1b6b1aab1c18b2Aa"><h3>Methods</h3><p>Characteristics showing significant associations (p &lt; 0.05) with overall survival (OS) or a trend (p &lt; 0.08) on multivariate analysis were used for the WBRT-30-BC. For each characteristic, 6-month OS rates were divided by 10. These scoring points were added for each patient (patient scores). The WBRT-30-BC was compared to the diagnosis- specific graded prognostic assessment (DS-GPA) classification and Rades-Score for breast cancer regarding positive predictive values (PPVs) to identify patients dying within 6 months and patients surviving at least 6 months following WBRT.</p></sec><sec id="j_raon-2019-0020_s_007_w2aab3b7b7b1b6b1aab1c18b3Aa"><h3>Results</h3><p>On multivariate analysis, Karnofsky performance score (KPS) was significant (risk ratio [RR]: 2.45, p &lt; 0.001). In addition, extra-cerebral metastatic disease (RR: 1.52, p = 0.071) and time between breast cancer diagnosis and WBRT (RR: 1.37, p = 0.070) showed a trend. Based on these three characteristics, four predictive groups were designed: 7–9, 10–12, 13–15 and 16 points. Six-month OS rates were 8%, 41%, 68% and 100% (p &lt; 0.001). PPVs to identify patients dying within 6 months were 92% (WBRT-30-BC), 84% (DS-GPA) and 92% (Rades-Score). PPVs to identify patients surviving for at least 6 months were 100% (WBRT-30-BC), 74% (DS-GPA) and 68% (Rades-Score).</p></sec><sec id="j_raon-2019-0020_s_008_w2aab3b7b7b1b6b1aab1c18b4Aa"><h3>Conclusions</h3><p>The WBRT-30-BC appeared very accurate in predicting death ≤ 6 months and survival ≥ 6 months of breast cancer patients receiving WBRT. It was superior to previous instruments in predicting survival ≥ 6 months.</p></sec></abstract>

BackgroundPrevious survival scores for breast cancer patients with cerebral metastases were developed in cohorts receiving heterogeneous treatments, which could have introduced selection biases. A new instrument (WBRT-30-BC) was created from 170 patients receiving whole-brain radiotherapy (WBRT) alone with 30 Gy in 10 fractions.MethodsCharacteristics showing significant associations (p < 0.05) with overall survival (OS) or a trend (p < 0.08) on multivariate analysis were used for the WBRT-30-BC. For each characteristic, 6-month OS rates were divided by 10. These scoring points were added for each patient (patient scores). The WBRT-30-BC was compared to the diagnosis- specific graded prognostic assessment (DS-GPA) classification and Rades-Score for breast cancer regarding positive predictive values (PPVs) to identify patients dying within 6 months and patients surviving at least 6 months following WBRT.ResultsOn multivariate analysis, Karnofsky performance score (KPS) was significant (risk ratio [RR]: 2.45, p < 0.001). In addition, extra-cerebral metastatic disease (RR: 1.52, p = 0.071) and time between breast cancer diagnosis and WBRT (RR: 1.37, p = 0.070) showed a trend. Based on these three characteristics, four predictive groups were designed: 7–9, 10–12, 13–15 and 16 points. Six-month OS rates were 8%, 41%, 68% and 100% (p < 0.001). PPVs to identify patients dying within 6 months were 92% (WBRT-30-BC), 84% (DS-GPA) and 92% (Rades-Score). PPVs to identify patients surviving for at least 6 months were 100% (WBRT-30-BC), 74% (DS-GPA) and 68% (Rades-Score).ConclusionsThe WBRT-30-BC appeared very accurate in predicting death ≤ 6 months and survival ≥ 6 months of breast cancer patients receiving WBRT. It was superior to previous instruments in predicting survival ≥ 6 months.

A new instrument for predicting survival of patients with cerebral metastases from breast cancer developed in a homogeneously treated cohort

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundPrevious survival scores for breast cancer patients with cerebral metastases were developed in cohorts receiving heterogeneous treatments, which...

Characteristic	OS at 3 months (%)	OS at 6 months (%)	OS at 9 months (%)	OS at 12 months (%)	P-value
Age
≤61 years	58	39	30	24
≥62 years	47	28	22	15	0.076
Karnofsky performance score
<70%	26	8	5
70%	54	32	19
>70%	89	72	60	51	<0.001
Time between first diagnosis of breast cancer
and WBRT
≤33 months	46	29	22	18
≥34 months	59	38	29	21	0.062
Systemic treatment prior to WBRT
No	45	23	11	11
Yes	53	35	28	21	0.27
Number of cerebral lesions
1-3	46	35	27	18
≥4	55	33	36	20	0.43
Controlled primary tumor
No	33	25	25	25
Yes	54	34	26	19	0.18
Extra-cerebral metastatic disease
No	76	53	43	36
Yes	45	28	21	15	0.001
Entire cohort	52	34	26	20

Characteristic	Number of patients	Proportion (%)
Age
≤61 years	85	50
≥62 years	85	50
Karnofsky performance score
<70%	76	45
70%	41	24
>70%	53	31
Time between first diagnosis of breast cancer and
WBRT
≤33 months	85	50
≥34 months	85	50
Systemic treatment prior to WBRT
No	22	13
Yes	148	87
Number of cerebral lesions
1-3	52	31
≥4	118	69
Controlled primary tumor
No	12	7
Yes	158	93
Extra-cerebral metastatic disease
No	38	22
Yes	132	78

Characteristic	6-month OS rate (%)	Scoring points
Karnofsky performance score
<70%	8	1
70%	32	3
>70%	72	7
Time between first diagnosis of breast cancer and WBRT
≤33 months	29	3
≥34 months	38	4
Extra-cerebral metastatic disease
No	53	5
Yes	28	3

Prognostic group	OS at 3 months (%)	OS at 6 months (%)	OS at 9 months (%)	OS at 12 months (%)	P-value
6-9 points	25	8	5	2
10-12 points	69	41	25	0
13-15 points	87	68	54	47
16 points	100	100	100	83	<0.001

A new instrument for predicting survival of patients with cerebral metastases from breast cancer developed in a homogeneously treated cohort

Article Category: Research Article

Published Online: May 08, 2019

Page range: 219 - 224

Received: Feb 12, 2019

Accepted: Mar 27, 2019

DOI: https://doi.org/10.2478/raon-2019-0020

© 2019 Stefan Janssen, Heinke C Hansen, Liesa Dziggel, Steven E Schild, Dirk Rades, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Univariate analyses of overall survival (OS); p-values were received from the Wilcoxon test.

Distribution of the patient characteristics

Six-month overall survival rates (OS) of the characteristics included in the WBRT-30-BC and the related scoring points

Overall survival (OS) rates of the four prognostic groups at 3, 6, 9 and 12 months following WBRT; the p-value was received from the Wilcoxon test