Refine
Document Type
- Article (2)
- Part of a Book (1)
Has Fulltext
- yes (3)
Keywords
- brain metastases (2)
- breast cancer (2)
- Darstellbarkeit (1)
- Dokumentarfilm (1)
- Judenvernichtung (1)
- Lanzmann, Claude (1)
- Shoah <Film> (1)
- Vergangenheitsbewältigung (1)
- asymptomatic (1)
- prognostic scores (1)
Institute
- Medizin (2)
Simple Summary: The incidence of brain metastases from breast cancer is increasing and the treatment is still a major challenge. Several scores have been developed in order to estimate the prognosis of patients with brain metastases by objective criteria. Here, we validated all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer patients with brain metastases in the Brain Metastases in the German Breast Cancer (BMBC) registry. Although all three available GPA-scores were associated with OS, they all show limitations mainly in predicting short-term (below 3 months) survival but also in long-term (above 12 months) survival. We discuss the test performances of all scores in our work and provide evidence how physicians should use them as a tool to select patients for different treatment options.
Abstract: Several scores have been developed in order to estimate the prognosis of patients with brain metastases (BM) by objective criteria. The aim of this analysis was to validate all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer (BC) patients with BM in the Brain Metastases in the German Breast Cancer (BMBC) registry. The median age at diagnosis of BM was 57 years. All in all, 22.3% of patients (n = 197) had triple-negative, 33.4% (n = 295) luminal A like, 25.1% (n = 221) luminal B/HER2-enriched like and 19.2% (n = 169) HER2 positive like BC. Age ≥60 years, evidence of extracranial metastases (ECM), higher number of BM, triple-negative subtype and low Karnofsky-Performance-Status (KPS) were all associated with worse overall survival (OS) in univariate analysis (p < 0.001 each). All three GPA-scores were associated with OS. The breast-GPA showed the highest probability of classifying patients with survival above 12 months in the best prognostic group (specificity 68.7% compared with 48.1% for the updated breast-GPA and 21.8% for the original GPA). Sensitivities for predicting 3 months survival were very low for all scores. In this analysis, all GPA-scores showed only moderate diagnostic accuracy in predicting the OS of BC patients with BM.
Characteristics and clinical outcome of breast cancer patients with asymptomatic brain metastases
(2020)
Simple Summary: The prognosis for patients with breast cancer that has spread to the brain is poor, and survival for these women hasn’t improved over the last few decades. We do not currently test for asymptomatic brain metastases in breast cancer patients, although this does happen in some other types of cancer. In this study we wanted to find out more about breast cancer that has spread to the brain and in particular to see whether there might be any advantage to spotting brain metastases before the development of neurological symptoms. Overall, our results suggest that women could be better off if their brain metastases are diagnosed before they begin to cause symptoms. We now need to carry out a clinical trial to see what happens if we screen high-risk breast cancer patients for brain metastases. This will verify whether doing so could increase survival, symptom control or quality of life.
Abstract: Background: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Results: Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, p = 0.01), had a better performance status at diagnosis (Karnofsky index 80–100%: 68.4% vs. 57%, p < 0.001), a lower number of BM (>1 BM: 56% vs. 70%, p = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, p < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, p = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, p < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.
Die Erfindung des Kinos hat man in Frankreich treffend kommentiert mit den Worten: "La vie est prise sur le vif." Durch die Wiedergabe der sichtbaren Wirklichkeit in bewegten Bildern wird der Eindruck des Lebendigen nicht wie auf Gemälden und selbst noch auf Fotografien buchstäblich festgehalten; vielmehr erscheinen die aufgenommenen Menschen und Dinge in dem Augenblick, da sie als bewegte und ebenso flüchtige Bilder auf die Leinwand projiziert werden, wie zu neuem Leben erweckt. An die Stelle des Gewesenen tritt das Gegenwärtige. Wenn Malerei und Fotografie aus dieser Perspektive als Medien der Verewigung bezeichnet werden können - so der Film als ein Medium steter Aktualisierung. Aufgrund dessen ist er aber auch in der Lage, eine dem Zuschauer überaus nahegehende Darstellung des Tötens zu geben. Insofern er fotografischen Realismus und lebendige Bewegung, theatralische Inszenierung und literarische Erzählweise kombiniert, kann er eindrucksvoller als alle anderen Medien das Publikum in Angst und Schrecken versetzen. Genau diese als besonders sinnlich gerühmten (oder gerügten) Qualitäten lassen es fraglich erscheinen, ob der Film geeignet ist, einen Einblick in den tiefsten Abgrund der Historie zu gewähren. Wenn grundsätzliche Bedenken gegen eine mögliche Darstellung der nationalsozialistischen Konzentrations- und Vernichtungslager geäußert werden, dann gelten sie insbesondere dem Film. Niemand würde mehr behaupten, dass etwa die Literatur das nicht könne oder nicht dürfe; Art Spiegelmans 'Maus' hat den Schriftgelehrten unterdessen vor Augen geführt, dass selbst eine graphic novel, nämlich ein Comic, als eine durchaus angemessene Form der Darstellung in Betracht kommen kann. Eine vergleichbar breite Zustimmung hat der Film, zumal der fiktionale, bisher nicht erreicht.