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The journal «ONCOSURGERY» 2013, Vol.5, No 3

Combined modality treatment (PDT and EBRT) for brain metastases of breast cancer

Zaitcev АМ, Kurzhupov МI, Reshetov IV, Filonenko ЕV

P.A. Herzen Moscow Cancer Research Institute, Moscow, Russia
Contact: Zaitsev AM, e-mail:

A case of long-term recurrence-free period and long survivance in female patient with brain metastases of breast cancer with history of combined modality treatment using intraoperative fluorescence diagnosis and photodynamic therapy which are not proved as standard treatment for brain metastases is represented.

Material and methods. Retrospective follow-up and analysis of combined modality treatment for intracerebral metastasis of breast cancer conducted in 2010-2012 were performed.

Statistics. The frequency of breast cancer metastasis is ranked in third place with brain metastasis diagnosed in 21% of patients. Continued growth of intracerebral metastasis occurs in 46-70% of patients who underwent previous excision of metastasis, in 69% of patients with stereotactic radiosurgery, in 52% of patients with whole brain irradiation, in 28-71% of patients received both stereotactic radiosurgery and whole brain irradiation. For brain metastasis median survival rates are as follows: without treatment – 1 month, using steroids – 2 months, after whole brain irradiation – 6 months, using stereotactic radiosurgery – 14 months, using surgery or stereotactic radiosurgery combined with whole brain irradiation –15 months.

Results. In 2007-2008 the patient had combined modality treatment for stage IIа right breast cancer T2N0M0 (26.10.07 – radical resection of right breast followed by 4 courses of polychemotherapy АС and external beam radiotherapy with total dose of 50 Gy on right breast, 44 Gy on right supraclavicular region, 40 Gy on right parasternal region; with tamoxifen administered since 2008). On August 27 and 28 2010 she had 2 generalized seizures with blackout. MRI of brain with contrast enhancement (09.09.2010) showed metastasis in left frontal lobe, functionally related brain area (speech centre – Broca’s area), for which on 15.09.10 the surgery including removal of metastatic tumor in left frontal lobe with intraoperative fluorescence diagnosis and photodynamic therapy was performed in Moscow Cancer Research Institute. There were no postoperative complications; control MRI of brain with contrast enhancement (16.09.10) proved removal of the tumor. On November-December 2010 the patient had EBRT with total dose of 60 Gy, single dose of 3 Gy (total dose up to 30 Gy for whole brain irradiation, then 30 Gy locally). The patient was examined regularly. MRI of brain with contrast enhancement (21.11.2011) showed recurrent metastatic tumor in left frontal lobe. On December 7 2011 the surgery including removal of metastatic tumor in left frontal lobe with intraoperative ultrasonography, fluorescence diagnosis and photodynamic therapy was performed in Moscow Cancer Research Institute. Control MRI of brain with contrast-enhancement (08.12.2011) proved removal of the tumor. The patient was discharged on 15.12.2011 with administration of chemotherapy with temodal up to July 2012. On July 2012 control MRI of brain with contrast enhancement showed no recurrence carcinoma or new metastasis, according to full examination there was no findings for progression of breast cancer.

Results of histological studies of surgical specimen: 07.12.11 – metastasis of adenocarcinoma; 15.09.2010 – meta-stasis of poor differentiated adenogenic cancer with solid structure; 2007 (from Russian Oncological Research Center) – ductal infiltrative cancer, grade 3; immunohistochemistry – ER ++, PR +.

Conclusion. Combined modality treatment for brain metastases, including surgical removal of metastasis with intraoperative fluorescence diagnosis and photodynamic therapy on tumor bed followed by radiotherapy is a highly effective method of treatment for brain metastases, particularly for functionally related zones of brain, where definite surgery is not feasible due to severe neurological impairment. This case also indicates the need for regular follow-up (recurrent metastasis was determined before neurological manifestation by control MRI of brain with contrast enhancement. According to statistics, the survival rate exceeded the median survival by 14.8 months, the patient is alive for 23 months. She is socially active and works in the specialty.

KEY WORDS: brain metastasis, breast cancer, whole brain irradiation, stereotactic radiosurgery, fluorescence diagnosis, intraoperative photodynamic therapy.

References

  1. Konovalov AN, Kozlov AV, Cherekaev VA, Golanov AV, Kobyakov GL, Belov AI, Zaitsev AM. Tumors of the central nervous system. Oncology: National guideness. M.: GEOTAR Media , 2008; 1012-44.
  2. Loshakov VA. Intracranial metastatic tumors. In.: Clinical Neurology. Vol. III. Ed. Konovalov AN. M.: 2005; 402-8.
  3. Filonenko EV. Fluorescence diagnostics and photodynamic therapy in oncology: Dis. Dr. med. Science. Moscow, 2006; 5-20.
  4. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys, 1997; 37: 745-51.
  5. Greenberg M. Cerebral metastases. In: Handbook of Neurosurgery. M.: Greenberg, ed. New York: Thieme, 2005; 463-9.
  6. Lang FF, Sawaya R. Metastatic Brain Tumors: Neuro-oncology. 2nd ed., New York: Thieme, 2008; 367-9.

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