Annals of Oncology 21: 2348–2355, 2010
Published online 3 May 2010
Incidence of and survival following brain metastases
among women with inflammatory breast cancer
S. Dawood1,2*, N. T. Ueno1, V. Valero1, E. Andreopoulou1, L. Hsu1, J. Lara1, W. Woodward3,
T. A. Buchholz3, G. N. Hortobagyi1& M. Cristofanilli1
1Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA;2Department of Medical Oncology, Dubai Hospital,
Dubai, United Arab Emirates;3Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Received 23 December 2009; revised 28 February 2010; accepted 24 March 2010
Background: The purpose of this study was to determine the incidence of and survival following brain metastases
among women with inflammatory breast cancer (IBC).
Patients and methods: Two hundred and three women with newly diagnosed stage III/IV IBC diagnosed from 2003
to 2008, with known Human epidermal growth factor receptor 2 (HER2) and hormone receptor status, were identified.
Cumulative incidence of brain metastases was computed. Survival estimates were computed using the Kaplan–Meier
product limit method. Multivariable Cox proportional hazards models were fitted to explore the relationship between
breast tumor subtype and time to brain metastases.
Results: Median follow-up was 20 months. Thirty-two (15.8%) patients developed brain metastases with
a cumulative incidence at 1 and 2 years of 2.7% and 18.7%, respectively. Eleven (5.3%) patients developed brain
metastases as the first site of recurrence with cumulative incidence at 1 and 2 years of 1.6% and 5.7%, respectively.
Compared with women with triple receptor-negative IBC, those with hormone receptor-positive/HER2-negative
disease [hazard ratio (HR) = 0.55, 95% confidence interval (CI) 0.19–1.51, P = 0.24] had a decreased risk of developing
brain metastases, and those with HER2-positive disease (HR = 1.02, 95% CI 0.43–2.40, P = 0.97) had an increased
risk of developing brain metastases, although these associations were not statistically significant. Median survival
following a diagnosis of brain metastases was 6 months.
Conclusion: Women with newly diagnosed IBC have a high early incidence of brain metastases associated with poor
survival and may be an ideal cohort to target for site-specific screening.
Key words: brain metastases, breast tumor subtypes, incidence, inflammatory breast cancer, risk, survival
Inflammatory breast cancer (IBC) is a rare and aggressive form
of breast cancer that accounts for ?1%–6% of all newly
diagnosed cases of breast cancer in the United States .
Historically, this disease was considered to be uniformly
fatal with <5% of women surviving beyond 5 years when
treated with surgery and/or radiotherapy [2, 3]. However, with
the introduction of a multimodality approach to the treatment
of IBC incorporating anthracycline-based primary systemic
chemotherapy, surgery and radiation therapy as essential
components of treatment, the survival of women with IBC
has improved considerably, with 5- and 10-year
overall survival rates of 40% and 33%, respectively, being
Data from large population-based epidemiological studies
have shown that the incidence of IBC is increasing dramatically
. This fact, coupled with the improved survival rates
attached with IBC and the known early recurrence of disease
compared with non-IBC tumors , will likely result in
a situation where more women with IBC will be alive
with metastatic disease. It thus becomes imperative to study the
patterns of recurrence, factors that predispose to recurrence
and survival following recurrence among women with IBC.
Metastasis to the brain is an important site of distant
metastatic disease occurring in ?10%–15% of women with
breast cancer . Although it is less common than other sites
of visceral or bone metastases, it is typically associated with
a comparatively poorer prognosis and recent data indicate
a trend toward increased brain recurrence probably due to
both increased use of sensitive methods of detection as well as
alteration of the natural history of breast cancer from
improved systemic treatments that are prolonging
survival [7, 8]. Thus, the objective of this retrospective study
was to study the incidence of and survival following
diagnosis of brain metastases among women diagnosed with
*Correspondence to: Dr S. Dawood, Department of Medical Oncology, Dubai Hospital,
Department of Health and Medical Services, PO Box 8179, Dubai, United Arab
Emirates. Fax: +97143-527776; E-mail: email@example.com
ª The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
All rights reserved. For permissions, please email: firstname.lastname@example.org
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25. Dawood S, Broglio K, Gong Y et al. Prognostic significance of HER-2 status in
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Annals of Oncology
Volume 21|No. 12| December 2010 doi:10.1093/annonc/mdq239 | 2355
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