title: Brain metastases of breast cancer.
abstract: Brain metastases of breast cancer remain a difficult problem for clinical management. Their incidence appears to be increasing, which is likely due to longer survival times for advanced breast cancer patients as well as additional and improved tools for detection. Molecular features of tumors associated with this syndrome are not yet understood. In general, survival may be improving for brain metastases due to better local control in the CNS, as well as improvements in systemic disease management. Selected patients with brain metastases are able to undergo surgical resection, which has been associated with extended disease control in some patients. However, whole-brain radiation has been the mainstay for treatment for most patients. Stereotactic radiosurgery is playing an increasing role in the primary treatment of brain metastases, as well as for salvage after whole-brain radiation. Recent series have reported median survivals of 13 months or longer with stereotactic radiosurgery. Further improvements in radiation-based approaches may come from ongoing studies of radiosensitizing agents. The ability of systemic treatments to impact brain metastases has been debated, and specific treatment regimens have yet to be defined. New approaches include chemotherapy combinations, biologic therapies and novel drug-delivery strategies.
authors.affiliation: Division of Hematology-Oncology, University of California at San Francisco, San Francisco, CA 94115, USA. mmelisko@medicine.ucsf.edu
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Melisko
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kunwar
authors.forename: Michael
authors.initials: M
authors.lastname: Prados
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: John W
authors.initials: JW
authors.lastname: Park
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D018579:Patient Selection; D011379:Prognosis; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D016634:Radiosurgery; D016879:Salvage Therapy; D013534:Survival
chemical_list: D011838:Radiation-Sensitizing Agents