Screening for Intracranial Disease in Patients With Metastatic Breast Cancer
Posted: Thursday, July 12, 2018
Some patients with metastatic breast cancer may benefit from MRI screening of the brain, “given the impact of neurologic compromise on quality of life,” according to Daniel N. Cagney, MD, of Dana-Farber/Brigham and Women’s Cancer Center, Boston, and colleagues. Their study findings, which were published in a research letter in JAMA Oncology, indicate that intracranial disease in this patient population was diagnosed at a later stage and did not appear to be more aggressive or resistant to treatment.
“Early identification of intracranial disease facilitates less invasive or less toxic approaches, such as stereotactic radiosurgery or careful use of promising systemic agents rather than [whole-brain radiation therapy] or neurosurgical resection,” the investigators commented. However, they noted, the NCCN does not recommend brain-directed screening for any patient with breast cancer, although this guideline is based solely on expert consensus and not on definitive or prospective studies.
Nearly 350 patients with newly diagnosed brain metastases secondary to breast cancer were evaluated between January 2000 and December 2015 at Dana-Farber/Brigham and Women’s Cancer Center. Nearly two-thirds of them had stage II or III cancer at initial diagnosis, and about three-quarters had neurologic symptoms.
In a comparison with more than 650 patients who had brain metastases secondary to non–small cell lung cancer, those with breast cancer presented with more advanced intracranial disease and more often needed whole-brain radiation therapyas initial management. However, there did not seem to be differences in recurrence or salvage therapy–based outcomes between the two groups after initial brain-directed therapy. As for neurologic death, it was more common in those with breast cancer than in those with lung cancer.