Her2/Neu brain mets
Started by Gfunk6
Not necessarily specific to Her2+ brain mets, but there is data that:
1) Resection leads to a high risk of leptomeningeal dissemination (comparing pre-op to post-op SRS, 3% vs 16%): Comparing Preoperative With Postoperative Stereotactic Radiosurgery for Resectable Brain Metastases: A Multi-institutional Analysis. - PubMed - NCBI
2) This is especially true with piecemeal resections and in posterior fossa (where anecdotally, piecemeal resections are more common): Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. - PubMed - NCBI and https://www.redjournal.org/article/S0360-3016(17)31488-8/fulltext
The second link suggests that breast cancer mets that are resected are more likely to result in LMD as well
Can't find anything on a brief google search for the exact answer to the question you're looking for
1) Resection leads to a high risk of leptomeningeal dissemination (comparing pre-op to post-op SRS, 3% vs 16%): Comparing Preoperative With Postoperative Stereotactic Radiosurgery for Resectable Brain Metastases: A Multi-institutional Analysis. - PubMed - NCBI
2) This is especially true with piecemeal resections and in posterior fossa (where anecdotally, piecemeal resections are more common): Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. - PubMed - NCBI and https://www.redjournal.org/article/S0360-3016(17)31488-8/fulltext
The second link suggests that breast cancer mets that are resected are more likely to result in LMD as well
Can't find anything on a brief google search for the exact answer to the question you're looking for
Sorry - don't have time to find them directly (other than evilbooyaa), but if you look into the background on some of these pre-op radiosurgery trials (I believe UAB and WashU have them) for larger brain mets, then you will see citations like those above from evilbooya.
Agree that I don't know of anything Her-2 specific though. So probably not that helpful.
academic.oup.com
Agree that I don't know of anything Her-2 specific though. So probably not that helpful.
RADI-12. LEPTOMENINGEAL FAILURE AFTER PREOPERATIVE VERSUS POSTOPERATIVE RADIOSURGERY
Abstract. INTRODUCTION: Postoperative stereotactic radiosurgery (postop SRS) is potentially complicated by difficulty defining the target volume and the ri
academic.oup.com
I guess it (significant CNS involvement in HER2/neu breast cancer) happens frequently enough that people have countenanced "crazy" stuff like this. Definitely have heard more than a few old school med oncs complain that the HER2 era has "caused" more brain mets (haven't you?) because the HER2 therapies are so effective extracranially I suppose. I haven't seen a post-craniotomy HER2 brain met patient. If I did, this would be a scenario where I would go postop whole brain and not go involved-site, as invidious as that sounds.
While doing PCI for Her2 disease seems ridiculous to me, I do wish it pushed our med oncs to at least get a screening MRI brain on all metastatic Her2+ patients. Routinely see folks 2 years into their MBC diagnosis without a single MRI brain who develop symptoms and get referred for big 3-4cm mets.
TNBC is also an issue...
This is one of those situations where preop SRS might make reasonable sense. Maybe in a handful of years with trial results
Indeed, but the question will then arise: How many of these surgeries could one have avoided with SRS?
I have had rash of recent Dural failures sp resection and cavity xrt in lung ca. (Yes, I put extra margin along dura.) Decided on 267 x 15 to failure given overlap with prior cavity srt. Initially was inclined to give whole brain but talked out of it by thought leader.
