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• W2055063911 abstract "Purpose/Objective(s)With new data pointing to a cohort of breast cancer patients at high risk of intracranial failure, the question of prophylactic cranial irradiation (PCI) has been raised. Although established in hematological malignancies and small cell lung cancer, no clinical experience exists for breast adenocarcinoma.Materials/MethodsIn a Phase I protocol, stage IIIB-IV breast cancer patients received induction chemotherapy with 6 cycles of 5-fluorouracil, methotrexate, leucovorin, escalating doses of epirubicin and the cardioprotector dexrazoxane. If complete remission was achieved, tandem autologous bone marrow transplantation followed. Patients in continued remission were consolidated with radiation to initial sites of disease and referred for PCI. Whole-brain radiotherapy was to be delivered at a dose of 36 Gy in 20 fractions.ResultsFrom 1995 to 1998, 24 patients were enrolled. Median age at study entry was 45 (range 28 to 60). Seventeen percent had inflammatory breast cancer and 83% hematogenous metastases. With a median follow-up of 9 years for surviving patients, the median survival from study entry was 27.5 months. Nine patients underwent PCI. The most common reason for not proceeding with PCI was failure to achieve complete remission. Eight of 24 patients developed brain metastases. In the PCI-treated group, 2 recurred in the brain, at 8 months and 7.5 years post-radiation. Because of bias induced by the study design, all long-term survivors (five are alive at 74–118 months) were those receiving PCI. Long-term complications have occurred in these patients, including two documented cases of neurocognitive impairment. Of these, a previously high-functioning patient required full care for leukoencephalopathy and treatment-related dementia.ConclusionsWe present a small series of patients with stage IIIB-IV breast cancer treated prophylactically with whole-brain radiotherapy following an aggressive chemotherapy regimen. Our data precludes any conclusion regarding the therapeutic benefit of PCI in this context. Nevertheless, with the potential for brain metastases despite PCI, and for serious long-term neurological sequelae, any further investigation of PCI in high-risk breast cancer will need to be approached with caution. Purpose/Objective(s)With new data pointing to a cohort of breast cancer patients at high risk of intracranial failure, the question of prophylactic cranial irradiation (PCI) has been raised. Although established in hematological malignancies and small cell lung cancer, no clinical experience exists for breast adenocarcinoma. With new data pointing to a cohort of breast cancer patients at high risk of intracranial failure, the question of prophylactic cranial irradiation (PCI) has been raised. Although established in hematological malignancies and small cell lung cancer, no clinical experience exists for breast adenocarcinoma. Materials/MethodsIn a Phase I protocol, stage IIIB-IV breast cancer patients received induction chemotherapy with 6 cycles of 5-fluorouracil, methotrexate, leucovorin, escalating doses of epirubicin and the cardioprotector dexrazoxane. If complete remission was achieved, tandem autologous bone marrow transplantation followed. Patients in continued remission were consolidated with radiation to initial sites of disease and referred for PCI. Whole-brain radiotherapy was to be delivered at a dose of 36 Gy in 20 fractions. In a Phase I protocol, stage IIIB-IV breast cancer patients received induction chemotherapy with 6 cycles of 5-fluorouracil, methotrexate, leucovorin, escalating doses of epirubicin and the cardioprotector dexrazoxane. If complete remission was achieved, tandem autologous bone marrow transplantation followed. Patients in continued remission were consolidated with radiation to initial sites of disease and referred for PCI. Whole-brain radiotherapy was to be delivered at a dose of 36 Gy in 20 fractions. ResultsFrom 1995 to 1998, 24 patients were enrolled. Median age at study entry was 45 (range 28 to 60). Seventeen percent had inflammatory breast cancer and 83% hematogenous metastases. With a median follow-up of 9 years for surviving patients, the median survival from study entry was 27.5 months. Nine patients underwent PCI. The most common reason for not proceeding with PCI was failure to achieve complete remission. Eight of 24 patients developed brain metastases. In the PCI-treated group, 2 recurred in the brain, at 8 months and 7.5 years post-radiation. Because of bias induced by the study design, all long-term survivors (five are alive at 74–118 months) were those receiving PCI. Long-term complications have occurred in these patients, including two documented cases of neurocognitive impairment. Of these, a previously high-functioning patient required full care for leukoencephalopathy and treatment-related dementia. From 1995 to 1998, 24 patients were enrolled. Median age at study entry was 45 (range 28 to 60). Seventeen percent had inflammatory breast cancer and 83% hematogenous metastases. With a median follow-up of 9 years for surviving patients, the median survival from study entry was 27.5 months. Nine patients underwent PCI. The most common reason for not proceeding with PCI was failure to achieve complete remission. Eight of 24 patients developed brain metastases. In the PCI-treated group, 2 recurred in the brain, at 8 months and 7.5 years post-radiation. Because of bias induced by the study design, all long-term survivors (five are alive at 74–118 months) were those receiving PCI. Long-term complications have occurred in these patients, including two documented cases of neurocognitive impairment. Of these, a previously high-functioning patient required full care for leukoencephalopathy and treatment-related dementia. ConclusionsWe present a small series of patients with stage IIIB-IV breast cancer treated prophylactically with whole-brain radiotherapy following an aggressive chemotherapy regimen. Our data precludes any conclusion regarding the therapeutic benefit of PCI in this context. Nevertheless, with the potential for brain metastases despite PCI, and for serious long-term neurological sequelae, any further investigation of PCI in high-risk breast cancer will need to be approached with caution. We present a small series of patients with stage IIIB-IV breast cancer treated prophylactically with whole-brain radiotherapy following an aggressive chemotherapy regimen. Our data precludes any conclusion regarding the therapeutic benefit of PCI in this context. Nevertheless, with the potential for brain metastases despite PCI, and for serious long-term neurological sequelae, any further investigation of PCI in high-risk breast cancer will need to be approached with caution." @default.
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• W2055063911 date "2007-11-01" @default.
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• W2055063911 title "Prophylactic Cranial Irradiation in Advanced Breast Cancer: Long-Term Results From a Trial of High-Dose Epirubicin and Tandem Autologous Bone Marrow Transplantation" @default.
• W2055063911 doi "https://doi.org/10.1016/j.ijrobp.2007.07.1195" @default.
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