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. 2025 Apr 22;167(1):112.
doi: 10.1007/s00701-025-06520-9.

Factors associated with local failure after stereotactic radiation to the surgical bed of patients with a single breast cancer metastasis

Ory Haisraely  1   2 , Marcia L Jaffe  3 , Yaacov R Lawrence  3   4 , Zvi Symon  3   4 , Anton Whol  4   5 , Thaila Kaisman-Elbaz  4   5 , Zvi R Cohen  4   5 , Alicia Taliansky  4   6 , Orit Kaidar-Person  3   4   7
Affiliations

Factors associated with local failure after stereotactic radiation to the surgical bed of patients with a single breast cancer metastasis

Ory Haisraely et al. Acta Neurochir (Wien). .

Abstract

Introduction: Breast cancer brain metastases (BCBM) are increasingly common due to improved systemic therapies prolonging survival. This study evaluates local control and factors influencing outcomes in patients with resected BCBM treated with postoperative stereotactic radiotherapy (SRT).

Methods: A retrospective review included single resected BCBM treated with postoperative SRT from 2010 to 2022. The median follow-up was 28 months (range, 14-43). Variables analyzed included tumor size, biology, surgical corridor inclusion, radiation dose, and timing of SRT. Multivariable analysis was conducted using Cox regression.

Results: 62 patients were analyzed in multivariable analysis, HER2-positive status was associated with improved local control (HR: 0.76, 95% CI: 0.36-0.88, p = 0.032), as was a higher biologically effective dose (BED > 40 Gy, HR: 0.65, 95% CI: 0.45-0.89, p = 0.028). In contrast, tumor size > 5 cm (HR: 2.1, 95% CI: 1.7-4.6, p = 0.021) and delayed initiation of SRT beyond 28 days post-surgery (HR: 2.7, 95% CI: 1.9-4.7, p = 0.015) were associated with worse outcomes. Age, cystic metastases, inclusion of surgical corridor, and tumor location were not significantly related to local control. Radiation necrosis occurred in 13% of patients, predominantly asymptomatic.

Conclusion: Postoperative SRT provides effective local control in resected BCBM. In multivariable analysis, HER2 positivity, higher BED, and timely SRT significantly influenced outcomes, while larger tumor size and delayed treatment were negative prognostic factors. Future research should optimize dosimetric strategies and integrate systemic therapy to improve local and intracranial control.

Keywords: Brain metastases; Breast cancer; Craniotomy; Postoperative radiotherapy; Radiosurgery.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: IRB approval number 0265–23-SMC. Consent for publication: This article has not been published before. All authors read this manuscript and approved it submission. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan Meier curve for surgical cavity control free survival according to brain metastasis histology
Fig. 2
Fig. 2
Brain MRI of a 46-year-old patient with luminal B breast cancer. Presenting symptoms of brain metastasis were headache and confusion (A). She underwent craniotomy for resection of a single brain metastasis at the left frontal lobe (A, B). The resection cavity was treated to a total dose of 30 Gy in 5 fractions, including the corridor (C). No evidence of local failure at time of last follow up
Fig. 3
Fig. 3
Brain MRI of a 59-year-old diagnosed with triple negative breast cancer. Presenting symptoms of brain metastasis was episode. Brain MRI showing a left parietooccipital cystic lesion (A). She underwent craniotomy (B, C – MRI of the surgical cavity) and the resection cavity was treated to a total dose of 25 Gy in 5 fractions not including the corridor and all surgical cavity (D, E, F, arrow). At 10 months she presented with local failure near the corridor (arrow) and a new brain metastasis (G, H)
See this image and copyright information in PMC

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