Abstract
Simple SummaryThirty percent of patients with human epidermal growth factor receptor 2-positive breast cancer and triple-negative breast cancer, and 15% of patients with the remaining subtypes of breast cancer will develop brain metastases. Available treatment methods include surgery and radiotherapy. However, some individuals will experience intracranial progression despite prior local treatment. This situation remains a challenge. In the case of progressing lesions amenable to local therapy, the choice of a treatment method must consider performance status, cancer burden, possible toxicity, and previously applied therapy. Stereotactic radiosurgery or fractionated radiotherapy rather than whole-brain radiotherapy should be used only if feasible. If local therapy is unfeasible, selected patients, especially those with human epidermal growth factor receptor 2-positive breast cancer, may benefit from systemic therapy.Survival of patients with breast cancer has increased in recent years due to the improvement of systemic treatment options. Nevertheless, the occurrence of brain metastases is associated with a poor prognosis. Moreover, most drugs do not penetrate the central nervous system because of the blood–brain barrier. Thus, confirmed intracranial progression after local therapy is especially challenging. The available methods of salvage treatment include surgery, stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), whole-brain radiotherapy, and systemic therapies. This narrative review discusses possible strategies of salvage treatment for progressive brain metastases in breast cancer. It covers possibilities of repeated local treatment using the same method as applied previously, other methods of local therapy, and options of salvage systemic treatment. Repeated local therapy may provide a significant benefit in intracranial progression-free survival and overall survival. However, it could lead to significant toxicity. Thus, the choice of optimal methods should be carefully discussed within the multidisciplinary tumor board.
Highlights
Breast cancer brain metastases (BCBM) represent the second most frequent secondary malignancy in the brain [1]
Progressive BCBM is defined as metastatic brain tumors from breast cancer that has been treated with any form of local therapy and recurred or progressed after it
This study suggested that postoperative radiotherapy after resection of progressive previously irradiated BCBM
Summary
Breast cancer brain metastases (BCBM) represent the second most frequent secondary malignancy in the brain [1]. It was found that the pooled cumulative incidence of BCBM was around 30% for the HER2-positive subgroup and the triple-negative subgroup, and 15% among patients with hormonal receptors positive HER2-negative breast cancer [6]. The most challenging situations comprise local progression after surgery or SRS/FSRT and disseminated intracranial progression after WBRT. In this narrative review, we aimed to summarize data on treatment methods and research directions of salvage treatment for progressive BCBM. We hope that it will be useful in the clinical management of these patients and will help to identify the optimal treatment methods.
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