Treatment Approaches for Brain Metastases in Breast Cancer

Tuesday, July 30, 2019

There are multiple ways to treat patients with breast cancer whose disease has spread to their brain, depending on the subtype of the disease, number of lesions, and more, according to Carey K. Anders, MD, a medical oncologist at Duke Cancer Center. 


The initial stages when patients are diagnosed, many times, we'll move forward with neurosurgical resection if there's a solitary lesion, or if the diagnosis is in question, or if there is a large space-occupying lesion that's causing the patient mass effect. Depending on whether or not neurosurgical resection is required, we then typically go to radiation therapy. I think that landscape may be changing in the future as our systemic therapies continue to advance. 

Traditionally, patients with a limited number of brain metastases will receive stereotactic radiosurgery to each of those lesions. If there are multiple lesions, and that number is debatable, potentially over 10, or diffuse dural-based disease, then patients will receive whole-brain radiation therapy. 

Then at that point, in consultation with the medical oncologist, based on the patient's subtype and presence or absence of extra-cranial disease, we'll recommend systemic therapies that are most appropriate. 

So the timing of each of these is important for each of the modalities of care to be discussed. I think there are multiple clinical trials looking at the timing and combinations, particularly of radiation therapy with system agents ongoing presently. 

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