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- W3094419523 abstract "Predicting the risk of early distant brain failure (DBF) is a useful and demanding resource for management decisions in patients who are candidates to local treatment of brain metastasis. This study aims to analyze the correlation between circulating tumor cells (CTC) and brain disease control after stereotactic radiotherapy/radiosurgery (SRT) for brain metastasis of breast cancer (BMBC). Prospective assessment of the number of CTC before (CTC1) and 4-5 weeks after (CTC2) SRT for BMBC and its relations with the number of suggestive lesions of BMBC (NL). In this analysis, final results of the 39 enrolled patients for the study between November 2016 and February 2018 are reported. Distant brain failure-free survival (DBFFS), the primary endpoint, diffuse distant brain failure-free survival (D-DBFFS), defined as progression with more than 4 new BMBC or meningeal carcinomatosis, and overall survival (OS) were estimated by Kaplan-Meier method. Log-rank statistics were used to identify prognostic factors affecting DBFFS and OS. Competing risk analysis for DBFSS was performed. For multivariate analysis, a Cox proportional model was applied. The median age at SRT was 54 years. Immunophenotype was HER2-positive in 51%, luminal B in 31% and triple negative in 18% of patients. CTC were detected in all 39 patients before SRT and the median CTC1 was 2 CTC/mL. After SRT, CTC was detected in 34 of 35 patients (4 deaths between CTC1 and CTC2) and the median CTC2 was 2.33 CTC/mL. With a median follow-up of 16.6 months, there were 15 patients with DBF, being 6 with diffuse distant brain failure (D-DBF), and 16 deaths. The median DBFFS, D-DBFFS and OS were 15.3, 14.1 and 19.5 months, respectively. The cumulative incidence, with death as competing risk factor, of DBF at 6 months was 40% in patients with CTC1 ≤0.5 and 8.82% in patients with CTC1 >0.5 (p = 0.007) and of D-DBF at 6 months was 40% in patients with CTC1 ≤0.5 and 0 in patients with CTC1 >0.5 (p = 0.005) and 25% in patients with NL/CTC1 >6.8 and 2.65% with NL/CTC1 ≤6.8 (p = 0.063). On multivariate analysis, DBFSS was inferior in patients with CTC1 ≤0.5 CTC/mL (HR 8.27, 95% CI 2.12-32.3; p = 0.002) and superior in patients with HER2-positive (HR 0.128, 95% CI 0.025-0.534; p = 0.013), D-DBFSS was inferior in patients with CTC1 ≤0.5 CTC/mL (HR 10.22, 95% CI 1.99-52.41; p = 0.005) and OS was superior in patients with immunophenotypes HER2-positive (HR 0.073, 95% CI 0.018-0.288; p<0.0001) and luminal B (HR 0.224, 95% CI 0.062-0.816; p = 0.023) and in patients with NL/CTC1 ≤2.2 (HR 0.159, 95% CI 0.05-0.505; p = 0.002). CTC were detectable in almost all patients with BMBC. CTC1 was an independent prognostic factor of DBFFS and D-DBFFS and NL/CTC1 was independent prognostic factor of OS and NL/CTC1 was a potential prognostic factor of D-DBF at 6 months. These data suggest that CTC1 and NL/CTC1 may be a role as a biomarker of early D-DBF, helping define the timing and type of salvage radiotherapy in order to optimize the control of BMBC (NCT02941536)." @default.
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- W3094419523 date "2020-11-01" @default.
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- W3094419523 title "Final Results of a Prospective Correlative Analysis of Circulating Tumor Cells and Early Distant Brain Failure after Stereotactic Radiotherapy/Radiosurgery for Brain Metastases of Breast Cancer" @default.
- W3094419523 doi "https://doi.org/10.1016/j.ijrobp.2020.07.958" @default.
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