- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Ha Son Nguyen
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
DOI:10.4103/2152-7806.189730Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Sharma A, Nguyen HS, Lozen A, Sharma A, Mueller W. Brain metastases from breast cancer during pregnancy. Surg Neurol Int 01-Sep-2016;7:
How to cite this URL: Sharma A, Nguyen HS, Lozen A, Sharma A, Mueller W. Brain metastases from breast cancer during pregnancy. Surg Neurol Int 01-Sep-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/brain-metastases-breast-cancer-pregnancy/
Background:Brain metastasis during pregnancy is a rare occurrence. In particular, there have only been three prior cases regarding breast cancer metastasis. We report a patient with breast cancer metastasis to the brain during pregnancy and review the literature.
Case Description:The patient was a 35-year-old female with a history of breast cancer (estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2/neu positive, status post-neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab therapy, status post-bilateral mastectomies), and prior right frontal brain metastases (status post-resection, capecitabine/lapatinib/temozolomide therapy, and cyberknife treatment). Patient was found to be pregnant at 9 weeks’ gestation while on chemotherapy; the patient elected to continue with the pregnancy and chemotherapy was discontinued. At 14 weeks’ gestation, she returned with recurrent right frontal disease. She was taken for a craniotomy at 16 weeks’ gestation, which confirmed metastases. Six weeks later, patient returned with worsening headaches and fatigue, with more recurrent right frontal disease. She was started on decadron and chemotherapy (5-fluorouracil, adriamycin, and cyclophosphamide). Serial magnetic resonance imaging (MRI) demonstrated enlarging right frontal lesions. She underwent a craniotomy at 27 weeks’ gestation, and chemotherapy was discontinued promptly. Starting at 30 weeks’ gestation, she received whole brain radiation for 2 weeks. Subsequently, she delivered a baby girl via cesarean section at 32 weeks’ gestation. At 6 weeks follow-up, an MRI brain demonstrated no new intracranial disease, with stable postoperative findings.
Conclusion:There is a lack of guidelines and clinical consensus on medical and surgical treatment for breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying tumor burden, location, gestational age of the fetus, and patient's preference and symptomatology.
Keywords: Brain metastases, brain surgery, breast cancer
Brain metastasis during pregnancy is a rare occurrence. In particular, there have only been three prior cases regarding breast cancer metastasis. Not surprisingly, pregnancy complicates the management of brain metastases. We report a patient with breast cancer metastasis to the brain during pregnancy and review the literature.
The patient was a 35-year-old female who had a history of breast cancer (invasive ductal carcinoma of the left breast, estrogen receptor (ER)/progesterone (PR) negative, human epidermal growth factor receptor 2 (HER2)/neu positive, status post-neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab therapy (TCH-P therapy), status post-bilateral mastectomies and left axillary lymph node dissection), with a prior right frontal brain metastases (status post-gross total resection, capecitabine/lapatinib/temozolomide therapy (TTX therapy), and cyberknife treatment). Patient was found pregnant at 9 weeks’ gestation; despite potential complications with the fetus during TTX therapy, patient elected to continue with the pregnancy; TTX therapy was discontinued. At 14 weeks’ gestation, she returned with headaches. Imaging showed recurrent right frontal dural-based lesion with significant surrounding vasogenic edema [
Six weeks later, patient returned with worsening headaches and fatigue. CT head showed recurring disease in the right frontal lobe [
The literature is limited regarding intracranial neoplasms during pregnancy. The estimated incidence is 15 per 100,000.[
Breast cancer is the most common malignancy during pregnancy.[
Chemotherapy for the treatment of breast cancer during pregnancy appears to be well-tolerated by the fetus; a large series reported 104 cases where chemotherapy was given starting at a mean gestational age of 20.4 weeks; the malformation rate of exposed neonates was not significantly different than the general population.[
Our patient is the fourth case of breast cancer metastases to the brain. She was able to undergo two craniotomies, at 16 weeks’ gestation and at 27 week's gestation, without surgical complications. Her baby was delivered at 32 weeks’ gestation; though the patient exhibited low gestational weight, the patient exhibited no malformation.
There is a lack of guidelines and clinical consensus on medical and surgical treatment for breast cancer metastases in pregnant patients. Treatment usually varies based upon underlying tumor burden, location, gestational age of the fetus, and patient's preference and symptomatology. In this patient, our treatment rationale was based upon prolonging the gestational age and attempted gross total-resection of the metastases.
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Conflicts of interest
There are no conflicts of interest.
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