1. Capecitabine and stereotactic radiation in the management of breast cancer brain metastases.
- Author
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Mills MN, Naz A, Thawani C, Walker C, Figura NB, Kushchayev S, Oliver DE, Etame AB, Yu HM, Robinson TJ, Liu JKC, Vogelbaum MA, Forsyth PA, Czerniecki BJ, Soliman HH, Han HS, and Ahmed KA
- Subjects
- Adult, Aged, Brain drug effects, Brain pathology, Brain radiation effects, Brain Neoplasms mortality, Breast Neoplasms diagnosis, Breast Neoplasms mortality, Breast Neoplasms therapy, Capecitabine administration & dosage, Chemoradiotherapy adverse effects, Chemoradiotherapy statistics & numerical data, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Middle Aged, Necrosis diagnosis, Necrosis etiology, Neoplasm Staging, Radiation Injuries diagnosis, Radiation Injuries etiology, Radiosurgery statistics & numerical data, Retrospective Studies, Treatment Outcome, Brain Neoplasms therapy, Breast Neoplasms pathology, Capecitabine adverse effects, Chemoradiotherapy methods, Radiosurgery adverse effects
- Abstract
Background: Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM)., Methods: Twenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist., Results: Median follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR-/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15-24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24-30 Gy) in a median of 5 fractions (range: 3-5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively., Conclusions: In our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.
- Published
- 2021
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