Background: Breast cancer brain metastasis (BCBM) confers a poor prognosis and is unusual in requiring multidisciplinary care in the metastatic setting. The University of North Carolina at Chapel Hill (UNC-CH) has created a BCBM clinic to provide medical and radiation oncology, neurosurgical, and supportive services to this complex patient population. We describe organization and design of the clinic as well as characteristics, treatments, and outcomes of the patients seen in its first 3 years.
Methods: Clinical and demographic data were collected from patients in a prospectively maintained database. Descriptive statistics are reported as percentages and means. The Kaplan-Meier method was used to estimate time-to-event outcomes.
Results: Sixty-five patients were seen between January 2012 and January 2015. At the time of presentation to the BCBM clinic, most patients (74%) had multiple (≥2) brain metastases and had received prior systemic (77%) and whole-brain radiation therapy and/or central nervous system stereotactic radiosurgery (65%) in the metastatic setting. Seventy-eight percent returned for a follow-up visit; 32% were enrolled in a clinical trial. Median time from diagnosis of brain metastasis to death was 2.11 years (95% confidence interval [CI] 1.31-2.47) for all patients, 1.15 years (95% CI 0.4-2.43) for triple-negative breast cancer, 1.31 years (95% CI 0.51-2.52) for hormone receptor-positive/HER2- breast cancer, and 3.03 years (95% CI lower limit 1.94, upper limit not estimable) for HER2+ breast cancer (p = .0037).
Conclusion: Patients with BCBM have unique and complex needs that require input from several oncologic disciplines. The development of the UNC-CH multidisciplinary BCBM clinic is a model that can be adapted at other centers to provide coordinated care for patients with a challenging and complex disease.
Implications for practice: Patients with breast cancer brain metastases often require unique multidisciplinary care to meet the numerous and uncommon challenges associated with their conditions. Here, the development and characteristics of a clinic designed specifically to provide for the multidisciplinary needs of patients with breast cancer brain metastases are described. This clinic may serve as a model for other institutions interested in creating specialty clinics with similar objectives.
摘要
背景. 乳腺癌脑转移 (BCBM) 预后不佳, 且因为转移性的性质而不常寻求多学科治疗。北卡罗来纳大学教堂山分校 (UNC-CH) 创立了一家 BCBM 诊所, 为这一复杂的患者群体提供肿瘤内科及肿瘤放疗科、神经外科和支持治疗。本文介绍了这家诊所的机构和设计, 以及最初3年收治患者的特征、治疗和转归。
方法. 从前瞻性保存的数据库中获取患者的临床和人口统计学数据。描述性统计数据以百分比和均值形式报告。使用 Kaplan-Meier 方法估算至事件发生时间的转归。
结果. 2012 年 1 月至 2015 年 1 月期间共有 65 例患者就诊。多数患者 (74%) 在 BCBM 诊所就诊时已经有多处 (≥2 处) 脑转移且既往曾接受过针对转移性病灶的系统性治疗 (77%) 或全脑放射治疗和/或中枢神经系统立体定向放射外科手术 (65%)。78%的患者回到诊所接受随访, 32%的患者进入临床试验。所有患者诊断为脑转移至死亡的中位时间为 2.11 年[95%可信区间 (CI) 1.31∼2.47], 三阴性乳腺癌患者为 1.15 年 (95%CI 0.4∼2.43), 激素受体+/HER2-乳腺癌患者为 1.31 年 (95%CI 0.51∼2.52), HER2+患者为 3.03 年 (95%CI 下限 1.94, 上限不可估计) (P = 0.0037)。
结论. BCBM 患者的需求独特且复杂, 需要多个肿瘤学科的投入。UNC-CH 多学科 BCBM 诊所的建立带来了难治性和综合性疾病患者的协作治疗经验, 为在其他中心建立类似诊所提供了一个范本。The Oncologist 2016;21:16–20
对临床实践的提示: 乳腺癌脑转移患者常需要多学科治疗以满足这类疾病众多的非常规需求。本文介绍了一家专为乳腺癌脑转移患者设计的诊所的建立和患者特征。这家诊所可能会成为其他有志于为类似患者建立专科诊所的中心的范本。
Keywords: Brain metastases; Breast cancer; Clinic; Multidisciplinary.
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