乳腺癌脑转移全脑放疗后综合治疗的疗效观察

Response to systemic treatment after whole-brain radiotherapy in different breast cancer subtypes patients with brain metastases

目的评估乳腺癌脑转移全脑放疗后不同分子亚型乳腺癌患者综合治疗的疗效。方法回顾性分析我院2002年1月至2010年12月间共101例乳腺癌脑转移患者的病例资料,其中48例全脑放疗后行综合治疗。根据患者雌激素、孕激素、人表皮生长因子受体2和Ki-67水平分为管腔A型、管腔B型、HER-2阳性型和三阴型4种生物亚型。自诊断脑转移开始计算生存时间,按照不同分子亚型放疗后的治疗情况分层分析,生存分析用Kaplan-Meier法。结果全脑放疗后未进行和进行综合治疗患者的中位生存时间分别为5.1个月和8.5个月(P<0.0001)。三阴型未进行和进行综合治疗患者的中位生存时间分别为4.8个月和6.1个月(P=0.051),管腔A型分别为5.3个月和11.0个月(P<0.0001),管腔B型分别为4.8个月和8.6个月(P<0.0001),HER-2阳性型分别为4.8个月和8.2个月(P<0.0001)。结论全脑放疗后综合治疗对管腔A型、管腔B型和HER-2阳性型乳腺癌脑转移患者能明显提高生存时间。

Objective To assess the role of systemic treatment after whole-brain radiotherapy （WBRT） in immunohistochemi- cally defined biological subsets of breast cancer patients with brain metastases. Methods The clinical data of 101 consecutive breast cancer patients with brain metastases treated in our hospital from Jan. 2002 to Dec. 2010 was analyzed retrospectively. Forty-eight pa- tients were received systemic treatment after WBRT. Patients were divided into 4 immunohistochemically biological subsets based on the levels of estrogen, progesterone, human epidermal growth factor receptor 2 （HER-2） and Ki-67 index, and labeled as luminal A, luminal B, HER-2 positive and triple-negative. Survival was calculated from brain metastases diagnosed. Patients from 4 subtypes were divided into 2 subgroups according to receiving systemic treatment after WBRT or not. Survival analysis was used by Kaplan-Meier method. Results The median survival time of patients received systemic treatment or not after WBRT were 5.1 and 8. 5 months, re- spectively （P 〈 0. 0001 ）. In the triple-negative subset, median survival of patients received systemic treatment or not were 4. 8 and 6. 1 months （P =0. 051 ）, in the luminal A subset were 5.3 and 11.0 months （P 〈0. 0001 ） ,in the luminal B subset were 4. 8 months and 8. 6 months, respectively （P 〈0. 0001 ）, in the HER-2 positive subset were 4. 8 months and 8. 2 months （P 〈0. 0001 ）. Conclu- sion Systemic therapy after WBRT appears to improve survival in patients with the luminal A, luminal B and HER-2 positive breast cancer subtypes.