gms | German Medical Science

CNS involvement of breast cancer is increasing as systemic treatment of metastatic breast cancer improves. The incidence of brain metastases (bm) in breast cancer is estimated to be up to 30%. Young age and oestrogen receptor negative disease seems to be a risk factor for developing bm in the literature and our own collective. Most patients present with symptoms like headache, cognitive disturbances, ataxia, nausea and vomiting or even seizures. MRI is superior to CT in detecting multiple lesions and / or leptomenigeal disease. Additionally cranial spinal fluid (CSF) examination may be performed in case of suspected leptomenigeal disease. The prognosis of bm is worse and dose usually not exceed 6 months. The one year survival rate is about 20% but the prognosis depends on the performance status as well as extracranial involvement. Corticosteroids may relief symptoms by decreasing cerebral edema surrounding brain metastases. The standard treatment of multiple (>3 lesions) bm is whole brain radiation (WBRT). Single lesions in patients with stable or absent extracranial disease may be successfully treated by surgery followed by WBRT. Stereotactic radiosurgery (SRS – gamma knife) has become popular and might be considered in patients who would be candidates for surgery especially if the patient is asymptomatic. Surgery offers immediate decompression. However, it seems that neither surgery nor SRS should be performed alone. The intact brain barrier excludes cytotoxic agents to penetrate into the brain. However, in case of brain metastases especially after WBRT the barrier probably becomes permeable for cytotoxic agents. Capecitabine, platin-analogues, idarubicine, topotecan and bendamustine have been reported to be active against bm in breast cancer but might be reserved for recurrent disease. Lepotmeningeal metastases are preferably treated by intrathecal chemotherapy e.g. methotrexate twice a week until clearance of CSF or liposomal cytarabine every 2nd week and every 4 week in the consolidation phase. The incidence of bm in breast cancer is rising, however treatment options are still unsatisfactory mainly because of little data, because most trials combine metastases of different solid tumours.