Karcinoza možganskih ovojnic in rak dojk
Leptomeningeal carcinomatosis and breast cancer

11-year treatment outcomes with radiation therapy

  • Tanja Žnidarič Oddelek za onkologijo, Univerzitetni klinični center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenija
  • Ivica Ratoša Onkološki inštitut Ljubljana https://orcid.org/0000-0002-5551-6616
Keywords: breast cancer, leptomeningeal carcinomatosis, radiation therapy, prognostic index

Abstract

Uvod: Karcinoza mening (LMK) nastane z zasevanjem tumorskih celic na možganske ovojnice in pomeni slabo prognozo. Obsevanje je ena izmed možnosti zdravljenja za ublažitev nevroloških simptomov.


Metode: V retrospektivno analizo smo vključili 423 bolnic z rakom dojk (RD) in možganskimi zasevki (MZ) ali LMK, ki so se v obdobju med 2005 in 2015 z obsevanjem glave zdravile na Onkološkem inštitutu Ljubljana. Podrobneje smo analizirali skupino bolnic z LMK, za katere smo tudi preverili uporabnost prognostičnih indeksov preživetja Breast Graded Prognostic Assessment (Breast-GPA) in Simple Survival Score for Brain Metastases (SS-BM).


Rezultati: Z obsevanjem glave smo v analiziranem obdobju zdravili 70 bolnic z LMK. Srednji čas od diagnoze RD do pojava LMK je znašal 4,3 leta, vendar je bil ta čas najkrajši pri trojno negativnem in najdaljši pri luminal A podtipu RD. Srednje celokupno preživetje je za bolnice z MZ in LMK znašalo 7,5 (95 % interval zaupanja, IZ; 6,3–8,8) ter 2,3 meseca (95 % IZ; 1,5–3,2) (p < 0,005), in se je razlikovalo tudi glede na molekularni podtip RD. Na daljše preživetje ni vplivala višja prejeta doza obsevanja (≤ 20Gy vs. > 20Gy), kakor tudi ne hiter pričetek obsevanja znotraj prvih dveh tednov po postavitvi diagnoze LMK. Indeksa Breast-GPA (p < 0,005) in SS-BM (p = 0,044) sta statistično značilno napovedala razlike v preživetju.


Zaključki: Pričakovano preživetje se je v naši skupini analiziranih bolnic z LMK razlikovalo glede na stanje zmogljivosti, molekularni podtip RD, čas od diagnoze LMK do pričetka z obsevanjem ter točke prognostičnih lestvic.


Abstract (Eng)

Introduction: Leptomeningeal carcinomatosis (LMC) develops with infiltration of leptomeninges by malignant cells and means poor prognosis. Radiotherapy presents one of the treatment options for neurological symptom relief.


Methods: We retrospectively analyzed 423 patients with breast cancer (BC) and brain metastasis (BM) or LMC, who received radiotherapy of the brain between the years 2005–2015 at the Institute of Oncology Ljubljana. We analyzed patients with LMC in more detail and performed a validation of prognostic survival indexes, namely Breast Graded Prognostic Assessment (Breast-GPA) and Simple Survival Score for Brain Metastases (SS-BM).


Results: Seventy patients with LMC were treated with whole-brain radiotherapy in observed time. Median time from BC diagnosis to LMC appearance was 4,3 years and was shortest in triple-negative and longest in luminal A BC subtype. Median overall survival for patients with BM and LMC was 7,5 (95 % confidence interval, CI; 6,3–8,8) and 2,3 months (95 % CI; 1,5–3,2), respectively (p < 0,005), and it varied depending on molecular BC subtype. Survival was not affected by a higher total dose of radiation received (≤ 20 Gy vs. > 20 Gy) or by the immediate start of radiotherapy within two weeks from LMC diagnosis. Breast-GPA (p < 0,005) and SS-BM (p = 0,044) indexes predicted survival with statistical significance.


Conclusions: Performance status, BC molecular subtype, time from LMC diagnosis till the start of radiotherapy and prognostic indexes were all factors which influenced expected survival in our group of analyzed LMC patients.

Published
2019-06-04
How to Cite
Žnidarič, T., & Ratoša, I. (2019). Leptomeningeal carcinomatosis and breast cancer. Onkologija : A Medical-Scientific Journal, 23(1), 18-26. Retrieved from https://revijaonkologija.si/Onkologija/article/view/409
Section
Original Scientific Article
Page
18-26