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Review
. 2024 Apr;200(4):259-275.
doi: 10.1007/s00066-024-02202-0. Epub 2024 Mar 15.

DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer

Kai J Borm  1 , Sophie T Behzadi  1 , Juliane Hörner-Rieber  2 , David Krug  3 , Rene Baumann  4 , Stefanie Corradini  5 , Marciana Nona Duma  6   7 , Jürgen Dunst  3 , Gerd Fastner  8 , Petra Feyer  9 , Rainer Fietkau  10 , Wulf Haase  11 , Wolfgang Harms  12 , Thomas Hehr  13 , Christiane Matuschek  14 , Marc D Piroth  15 , Leonard Christopher Schmeel  16 , Rainer Souchon  17 , Vratislav Strnad  10 , Wilfried Budach  14 , Stephanie E Combs  18   19   20 ; Breast Cancer Expert Panel of the German Society of Radiation Oncology DEGRO
Affiliations
Review

DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer

Kai J Borm et al. Strahlenther Onkol. 2024 Apr.

Abstract

Purpose: The aim of this review was to evaluate the existing evidence for radiotherapy for brain metastases in breast cancer patients and provide recommendations for the use of radiotherapy for brain metastases and leptomeningeal carcinomatosis.

Materials and methods: For the current review, a PubMed search was conducted including articles from 01/1985 to 05/2023. The search was performed using the following terms: (brain metastases OR leptomeningeal carcinomatosis) AND (breast cancer OR breast) AND (radiotherapy OR ablative radiotherapy OR radiosurgery OR stereotactic OR radiation).

Conclusion and recommendations: Despite the fact that the biological subtype of breast cancer influences both the occurrence and relapse patterns of breast cancer brain metastases (BCBM), for most scenarios, no specific recommendations regarding radiotherapy can be made based on the existing evidence. For a limited number of BCBM (1-4), stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SRT) is generally recommended irrespective of molecular subtype and concurrent/planned systemic therapy. In patients with 5-10 oligo-brain metastases, these techniques can also be conditionally recommended. For multiple, especially symptomatic BCBM, whole-brain radiotherapy (WBRT), if possible with hippocampal sparing, is recommended. In cases of multiple asymptomatic BCBM (≥ 5), if SRS/SRT is not feasible or in disseminated brain metastases (> 10), postponing WBRT with early reassessment and reevaluation of local treatment options (8-12 weeks) may be discussed if a HER2/Neu-targeting systemic therapy with significant response rates in the central nervous system (CNS) is being used. In symptomatic leptomeningeal carcinomatosis, local radiotherapy (WBRT or local spinal irradiation) should be performed in addition to systemic therapy. In patients with disseminated leptomeningeal carcinomatosis in good clinical condition and with only limited or stable extra-CNS disease, craniospinal irradiation (CSI) may be considered. Data regarding the toxicity of combining systemic therapies with cranial and spinal radiotherapy are sparse. Therefore, no clear recommendations can be given, and each case should be discussed individually in an interdisciplinary setting.

Keywords: Craniospinal irradiation; Molecular profile; Neurocognitive side effects; Radiosurgery; Whole-brain radiotherapy.

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Conflict of interest statement

K.J. Borm has received honoraria from Accuray. D. Krug has received honoraria from Merck Sharp & Dome, med update, onkowissen, best practice onkologie, ESO, ESMO, Gilead, Astra Zeneca, and Pfizer as well as research funding from Merck KGaA. S.T. Behzadi, J. Hörner-Rieber, R. Baumann, S. Corradini, M.N. Duma, J. Dunst, G. Fastner, P. Feyer, R. Fietkau, W. Haase, W. Harms, T. Hehr, C. Matuschek, M.D. Piroth, L.C. Schmeel, R. Souchon, V. Strnad, W. Budach and S.E. Combs declare that they have no competing interests.

References

    1. DeSantis CE, Bray F, Ferlay J, Lortet-Tieulent J, Anderson BO, Jemal A. International Variation in Female Breast Cancer Incidence and Mortality Rates. Cancer Epidemiol Biomarkers Prev. 2015;24(10):1495–1506. - PubMed
    1. Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto W, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, Yu J, Chiang V, Nakano T, Aoyama H, Mehta MP. Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today. Int J Radiat Oncol Biol Phys. 2020;107(2):334–343. - PMC - PubMed
    1. Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto WA, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, An Y, Chiang V, Nakano T, Aoyama H, Mehta MP. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J Clin Oncol. 2020;38(32):3773–3784. - PMC - PubMed
    1. Palmer, J. D., B. G. Klamer, K. V. Ballman, P. D. Brown, J. H. Cerhan, S. K. Anderson, X. W. Carrero, A. C. Whitton, J. Greenspoon, I. F. Parney, N. N. I. Laack, J. B. Ashman, J. P. Bahary, C. G. Hadjipanayis, J. J. Urbanic, F. G. Barker, 2nd, E. Farace, D. Khuntia, C. Giannini, J. C. Buckner, E. Galanis and D. Roberge (2022). “Association of Long-term Outcomes With Stereotactic Radiosurgery vs Whole-Brain Radiotherapy for Resected Brain Metastasis: A Secondary Analysis of The N107C/CEC.3 (Alliance for Clinical Trials in Oncology/Canadian Cancer Trials Group) Randomized Clinical Trial.” JAMA Oncol 8(12): 1809–1815. - PMC - PubMed
    1. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22(14):2865–2872. - PubMed

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