立体定向放射外科治疗人表皮受体 2 阳性乳腺癌脑转移：一项国际多中心研究。
Stereotactic radiosurgery for brain metastases from human epidermal receptor 2 positive breast Cancer: an international, multi-center study.
发表日期：2024 Aug 27
作者：
Stylianos Pikis, Georgios Mantziaris, Maria Protopapa, Salem M Tos, Roman O Kowalchuk, Richard Blake Ross, Chad G Rusthoven, Manjul Tripathi, Anne-Marie Langlois, David Mathieu, Cheng-Chia Lee, Huai-Che Yang, Selcuk Peker, Yavuz Samanci, Michael Yu Zhang, Steve E Braunstein, Zhishuo Wei, Ajay Niranjan, Dade L Lunsford, Jason Sheehan
来源：
Brain Structure & Function
摘要：
报告一组活检证实的 HER-2 阳性乳腺癌患者接受立体定向放射外科 (SRS) 治疗脑转移 (BM) 的患者结果和局部肿瘤控制率。这项国际回顾性多中心研究纳入了 195 名女性患者1706 SRS 处理的 BM。确定 SRS 后的放射学和临床结果，并确定预后因素。在 SRS 中，患者中位年龄为 55 岁 [四分位距 (IQR) 47.6-62.0]，156 名 (80%) 患者的 KPS ≥ 80。中位肿瘤体积为0.1 cm3 (IQR 0.1-0.5)，中位处方剂量为 16 Gy (IQR 16-18)。 SRS 后 6、12、24、36 和 60 个月的局部肿瘤控制 (LTC) 率分别为 98%、94%、93%、90% 和 88%。多变量分析显示，肿瘤体积 (p = < 0.001) 和并行帕妥珠单抗 (p = 0.02) 改善了 LTC。 6、12、24、36、48 和 60 个月的总生存 (OS) 率分别为 90%、69%、46%、27%、22% 和 18%。并行帕妥珠单抗改善了 OS (p = 0.032)。在该患者亚组中，GPA 评分 ≥2.5（p = 0.038 和 p = 0.003）和罕见的原发性肿瘤组织学（p = 0.01）分别与 OS 升高和降低相关。 27 名 (14.0%) 患者发生无症状不良辐射事件 (ARE)，5 名 (2.6%) 患者发生有症状 ARE。原发性浸润性小叶癌 (p = 0.042) 和并发帕妥珠单抗 (p < 0.001) 会增加整体风险，但不会增加症状性 ARE。SRS 为选定的 HER-2 阳性乳腺癌 BM 患者提供有效的 LTC。并行帕妥珠单抗改善了 LTC 和 OS，但同时增加了总体风险，但不是症状性 ARE。© 2024。作者。
To report patient outcomes and local tumor control rates in a cohort of patients with biopsy-proven HER-2 positive breast cancer treated with stereotactic radiosurgery (SRS) for brain metastases (BM).This international, retrospective, multicenter study, included 195 female patients with 1706 SRS-treated BM. Radiologic and clinical outcomes after SRS were determined and prognostic factors identified.At SRS, median patient age was 55 years [interquartile range (IQR) 47.6-62.0], and 156 (80%) patients had KPS ≥ 80. The median tumor volume was 0.1 cm3 (IQR 0.1-0.5) and the median prescription dose was 16 Gy (IQR 16-18). Local tumor control (LTC) rate was 98%, 94%, 93%, 90%, and 88% at six-, 12-, 24-, 36- and 60-months post-SRS, respectively. On multivariate analysis, tumor volume (p = < 0.001) and concurrent pertuzumab (p = 0.02) improved LTC. Overall survival (OS) rates at six-, 12-, 24-, 36-, 48-, and 60-months were 90%, 69%, 46%, 27%, 22%, and 18%, respectively. Concurrent pertuzumab improved OS (p = 0.032). In this patient subgroup, GPA scores ≥ 2.5 (p = 0.038 and p = 0.003) and rare primary tumor histologies (p = 0.01) were associated with increased and decreased OS, respectively. Asymptomatic adverse radiation events (ARE) occurred in 27 (14.0%) and symptomatic ARE in five (2.6%) patients. Invasive lobular carcinoma primary (p = 0.042) and concurrent pertuzumab (p < 0.001) conferred an increased risk for overall but not for symptomatic ARE.SRS affords effective LTC for selected patients with BM from HER-2 positive breast cancer. Concurrent pertuzumab improved LTC and OS but at the same time increased the risk for overall, but not symptomatic, ARE.© 2024. The Author(s).