CLINICO-PATHOLOGIC PROFILE AND TREATMENT OUTCOMES OF BRAIN METASTASES FROM BREAST CANCER IN IBADAN, NIGERIA

AYANDIPO O.O^1*, ADELEYE A.O2, OGUNDIRAN T.O.^1
1Division of Oncological Surgery, Department of Surgery, College of Medicine, University of Ibadan /University College Hospital Ibadan, Nigeria
²Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan/ University College Hospital Ibadan, Nigeria

*Corresponding Author: Dr. O.O Ayandipo Email: yokebukola@yahoo.com
Source of grant: None
Conflict of Interest: None

ABSTRACT

Background: The development of brain metastases (BM) in breast cancer portends a significant systemic disease-progression for the patients. In sub-Saharan Africa, BM is wont to be seen as a terminal stage event in breast cancer. This study profiles BM among patients with breast cancer in an African oncological surgery practice. Aims and Objectives: To study the clinico-pathologic profile and treatment outcomes of BM from breast cancer.

Methods: Over a 10-year period ending in December 2017, patients treated for breast cancer were followed up prospectively till development of BM. Each patient was enlisted at presentation into the Oncology database and followed up till development of BM if any. Clinical, histopathologic, radiologic and treatment details were extracted from the source data. Statistical analysis was done using SPSS Version 20.0. Univariate analysis was performed using the log rank test to compare overall survival between groups. Cox regression analysis was done to determine factors associated with the median survival time. This study is a descriptive observation for the occurrence of BM among these subjects. Statistically significance was set at a p value < 0.05.

Results: Of the 1971 histologically diagnosed breast cancer patients who underwent treatment over the study period, 266 (13.5%), females developed BM, although analysis was for 219 who had complete details. The median age was 46 (range 32-67 years). Synchronous disease was in 44 (20.1%) patients while 175 (79.9%) had metachronous disease. Invasive ductal carcinoma constituted 157 (71.7%) patients; 200 (91.3%) patients had either intermediate or high-grade lesions. One hundred and forty-eight (67.6%) had stage III or IV disease at time of primary diagnosis. Luminal A, Her2 and Basal-like were present in 97 (57.5%), 38 (23.1%) and 33 (19.4%) respectively out of 168. For the primary treatment of the breast cancer 162 (74.0%) had radical mastectomy and 210 (95.9%) had chemotherapy. Seventy- three (33.3%) had adjuvant external beam radiotherapy; 27 (12.3%) had been treated with Transtuzumab-Herceptin and 78 (35.6%) with hormone therapy. Ninety-eight (44.7%) had controlled locoregional disease while 121 (55.3%) had uncontrolled locoregional disease at the time of BM. The main neurological symptoms patients presented with were headaches in 192 (87.8%), paresis in 184 (84.0%), seizures in 114 (52.1%), altered mental state in 109 (49.8%) and visual complaints in 96 (43.8%). The cerebrum and cerebellum were involved in metastases in 106 (57.9%) and 57 (31.1%) respectively. The BM were multiple in 54.6% and solitary in 46.4% of patients. GPA-B was = 2.0 in a total of 153 (69.9%) patients. All had steroid therapy; 96 (43.8%) had in addition whole brain radiotherapy (WBRTH) and 32 (14.6%) had in addition both metastasectomy and WBRTH. Two hundred and eight (95%) had died of disease at the end of the study period. Controlled locoregional disease, GPA =2.5 and Karnofsky score =70 were associated with longer survival.

Conclusion: Brain metastases occurred in 13.5% of our patients, with the patients having a median age of 46 years. Most of them had metachronous disease with predominance of invasive ductal carcinoma of intermediate/high grade histopathologic type, nodal involvement and stage III or IV disease at breast cancer diagnosis. Most cancers were Luminal A. The main treatment for the primary cancer had been surgery and chemotherapy. Neurological symptoms were mainly headaches, limb paresis, seizures and altered mental state. The cerebrum and cerebellum were the commonest sites of metastases, and multiple lesions were more common than solitary ones. Treatment with WBRTH and steroids, or steroids alone was the most commonly used, with metastasectomy in a few patients. The median survival after BM diagnosis was 4.6 months. Controlled locoregional disease, GPA=2.5, and Karnofsky score =70 were associated with longer survival. Brain metastases are not uncommon, and appear to portend end-stage disease for a significant proportion of patients with breast cancer in our setting.

Key words:Breast cancer, Brain metastases, GPA-B, Karnofsky score, Management, Outcome, Ibadan