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Review
. 2022 Mar 15;14(6):1514.
doi: 10.3390/cancers14061514.

Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift

Edy Ippolito  1 , Sonia Silipigni  1 , Paolo Matteucci  1 , Carlo Greco  1 , Sofia Carrafiello  1 , Vincenzo Palumbo  1 , Claudia Tacconi  1 , Claudia Talocco  1 , Michele Fiore  1 , Rolando Maria D'Angelillo  2 , Sara Ramella  1
Affiliations
Review

Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift

Edy Ippolito et al. Cancers (Basel). .

Abstract

Brain metastases (BMs) are common among patients affected by HER2+ metastatic breast cancer (>30%). The management of BMs is usually multimodal, including surgery, radiotherapy, systemic therapy and palliative care. Standard brain radiotherapy (RT) includes the use of stereotactic radiotherapy (SRT) for limited disease and whole brain radiotherapy (WBRT) for extensive disease. The latter is an effective palliative treatment but has a reduced effect on brain local control and BM overall survival, as it is also associated with severe neurocognitive sequelae. Recent advances both in radiation therapy and systemic treatment may change the paradigm in this subset of patients who can experience long survival notwithstanding BMs. In fact, in recent studies, SRT for multiple BM sites (>4) has shown similar efficacy when compared to irradiation of a limited number of lesions (one to three) without increasing toxicity. These findings, in addition to the introduction of new drugs with recognized intracranial activity, may further limit the use of WBRT in favor of SRT, which should be employed for treatment of both multiple-site BMs and for oligo-progressive brain disease. This review summarizes the supporting literature and highlights the need for optimizing combinations of the available treatments in this setting, with a particular focus on radiation therapy.

Keywords: HER2+; brain metastases; multimodal treatment; radiosensitization; side effects; stereotactic radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evolution of brain radiotherapy (from left to right): (1) WBRT; (2) HA-WBRT; (3) WBRT + SIB; (4) multiple-site SRT.
Figure 2
Figure 2
Proposed algorithm for newly diagnosed HER2 BMs.
Figure 3
Figure 3
Proposed algorithm for recurrent HER2 BMs after brain RT.
Figure 4
Figure 4
RN incidence reported in studies investigating the association between SRT and systemic therapies.
See this image and copyright information in PMC

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