A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience
A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience
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DOI：
10.1634/theoncologist.2015-0328
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发表时间：
2016-01-01
期刊：
影响因子：
5.8
通讯作者：
Zagar, Timothy M.
中科院分区：
文献类型：
--
作者：
McKee, Megan J.;Keith, Kevin;Zagar, Timothy M.
背景乳腺癌脑转移（BCBM）预后差，在转移性疾病中需要多学科治疗是不寻常的。位于查佩尔山的北卡罗来纳州大学（UNC-CH）创建了一个BCBM诊所，为这一复杂的患者群体提供医疗和放射肿瘤学、神经外科和支持性服务。我们描述的组织和设计的诊所，以及特点，治疗，并在其前3年看到的病人的结果。在前瞻性维护的数据库中收集患者的临床和人口统计学数据。描述性统计量报告为百分比和平均值。Kaplan-Meier法用于估计事件发生时间。2012年1月至2015年1月期间共观察到65例患者。在到BCBM诊所就诊时，大多数患者（74%）有多个（>= 2个）脑转移瘤，并在转移性背景下接受过既往全身（77%）和全脑放射治疗和/或中枢神经系统立体定向放射外科治疗（65%）。78%的人返回进行随访; 32%的人参加了临床试验。从诊断脑转移到死亡的中位时间为2.11年（95%置信区间[CI] 1.31-2.47），所有患者，1.15年（95% CI 0.4-2.43）三阴性乳腺癌，1.31年激素受体阳性/HER 22乳腺癌的存活时间为3.03年（95%CI下限1.94，上限无法估计）（p=.0037）。结论。BCBM患者有独特而复杂的需求，需要多个肿瘤学科的输入。UNC-CH多学科BCBM诊所的发展是一种可以在其他中心进行调整的模式，为患有挑战性和复杂疾病的患者提供协调的护理。
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/HER22 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.