Treatment of cerebral metastases from breast cancer with stereotactic radiosurgery.
OBJECTIVE
The role of stereotactic radiosurgery (SRS) alone or in combination with whole brain radiotherapy (WBRT) in the treatment of cerebral metastases from breast carcinoma is discussed controversially. To elucidate the role of SRS in this context, a retrospective study evaluating the benefit of SRS and prognostic factors for survival was performed.


METHODS
From 1986 to 2003, 62 patients with cerebral metastases from breast cancer were treated for 103 lesions. Ten patients received SRS alone (group 1), 13 patients were treated with WBRT and SRS as a focal boost (group 2), and 39 patients received WBRT and salvage SRS (group 3) for recurrent metastases at a later time point.


RESULTS
Survival was increased in patients receiving SRS only compared to WBRT and SRS as a focal boost. Patients < 40 years of age had a favorable outcome (p > 0.04). However, no other prognostic factors could be identified. Overall tolerance of radiation was acceptable. Median local control intervals were 9 months for all patients, 6.5 months in group 1, 4 months in group 2, and 9 months in group 3, respectively. There were no significant intergroup differences.


CONCLUSIONS
SRS alone is an effective treatment for patients with one to three brain metastases from breast cancer. A randomized trial should be performed to evaluate whether WBRT is a necessary component in the primary treatment of these patients. Salvage SRS is an effective therapy option after WBRT.
Combs
Stephanie E
SE
Department of Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. S.Combs@dkfz.de
Schulz-Ertner
Daniela
D
Thilmann
Christoph
C
Edler
Lutz
L
Debus
Jürgen
J
D000328:Adult; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013534:Survival; D016019:Survival Analysis; D016896:Treatment Outcome