title: [The outcome of surgery and radiotherapy in treatment of brain metastases of breast carcinoma].
abstract: In a group of 45 patients who had been conventionally irradiated, a multivariate analysis of prognostic factors was performed to find criteria for patient selection for surgery and radiotherapy or radiotherapy only. Nine patients underwent resection of metastases before irradiation. In most cases 10 x 3 Gy over 2 weeks were administered. 28 patients received concomitant hormonal treatment. Complete remission was seen in 30% of the non-operated cases (partial remission 25%). Symptomatic relief was seen in 67% of all cases. Median survival was 4 months (9.5 months after surgery) (p = 0.02). Survival of patients having had simultaneous extracerebral metastases and low Karnofsky performance status was disappointing. All long-time survivors received either hormonal treatment or chemotherapy. Karnofsky performance status and interval between the diagnosis of the primary tumour and the development of brain metastases were the most important prognostic factors. The influence of age and extracerebral metastases was less pronounced. In case of favourable prognostic factors and solitary metastases surgical treatment should be considered. Primary irradiation seems to be appropriate for the majority of patients. In any case an additional hormonal or chemotherapy must be considered. It seems to be questionable if patients with poor Karnofsky performance status and extracerebral metastases should be irradiated.
authors.affiliation: Abteilung für Strahlentherapie der Radiologischen Klinik, Universität des Saarlandes, Homburg/Saar.
authors.forename: C
authors.initials: C
authors.lastname: Nieder
authors.forename: M
authors.initials: M
authors.lastname: Niewald
authors.forename: K
authors.initials: K
authors.lastname: Walter
authors.forename: K
authors.initials: K
authors.lastname: Schnabel
authors.forename: C
authors.initials: C
authors.lastname: Villena-Heinsen
authors.forename: W
authors.initials: W
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
vernacular_title: Stellenwert von Operation und Strahlentherapie in der Behandlung von Hirnmetastasen des Mammakarzinoms.