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Breast cancer—what about radiosurgery for brain metastasis?

Nature Reviews Clinical Oncology volume 8, page 506 (2011)Cite this article

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We read with great interest the recently published Review by Chargari et al. in Nature Reviews Clinical Oncology (Whole-brain radiation therapy in breast cancer patients with brain metastases. Nat. Rev. Clin. Oncol. 7, 632–640).1 The authors discussed the challenges of treating brain metastases, the current strategies of treatment combination, and available radiation therapy techniques that improve efficacy and decrease or prevent neurological toxicity.

The article by Chargari et al.1 focuses on strategies that include whole-brain radiation therapy (WBRT) because many patients with brain metastases from breast cancer are preferentially treated with WBRT.2,3,4 In historical series, WBRT increased median overall survival time by 3–4 months versus 1 month without treatment and 2 months with corticosteroid alone.5 The most common WBRT regimen is 30 Gy delivered in 10 fractions, which is proposed for patients in recursive partitioning analysis stage III (42% of patients with metastatic breast cancer).6 Controversy still exists regarding therapeutic strategies and the impact of WBRT is still unclear. Patchell et al.7 reported that withholding upfront WBRT was associated with a significantly higher risk of cranial distant recurrence. In three randomized controlled trials comparing upfront stereotactic radiation surgery (SRS) with or without WBRT, these results were confirmed and no significant difference was reported in overall survival rates.8,9,10 Nevertheless, in the study conducted by Aoyama,6 although WBRT reduced the brain recurrence rate at 6 months in the high-risk group (extracranial metastases or multiple brain metastases) from 57% to 21%, this difference was no longer observed at 12 months. For the low-risk group (no extracranial metastases and a single brain metastasis) two-thirds of the patients had no regional brain recurrence at 12 months when they are treated by radiosurgery alone.

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Authors and Affiliations

  1. Oncology Radiotherapy Department, CHU Timone, Assistance Publique de Marseille, 264 Boulevard Jean Moulin, Marseille cedex 5, 13385, France

    Laetitia Padovani & Xavier Muracciole

  2. Neurosurgery Department, CHU Timone, Assistance Publique de Marseille, 264 Boulevard Jean Moulin, Marseille cedex 5, 13385, France

    Jean Marie Regis

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  1. Laetitia Padovani
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  2. Jean Marie Regis
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Correspondence to Laetitia Padovani.

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The authors declare no competing financial interests.

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Padovani, L., Regis, J. & Muracciole, X. Breast cancer—what about radiosurgery for brain metastasis?. Nat Rev Clin Oncol 8, 506 (2011). https://doi.org/10.1038/nrclinonc.2010.119-c1

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