Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

Abstract

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10-30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.

Fig. 1

Algorithm for the initial treatment of brain metastases. Asterisk In all cases consider systemic treatment by tumor subtype. KPS Karnofsky performance status, SRS stereotactic radiosurgery, WBRT whole-brain radiotherapy, ±WBRT omission of up-front WBRT is an alternative in patients who are closely observed for progression after surgery or SRS and have an active systemic treatment