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CNS Metastases in Breast Cancer
Nancy U. Lin, Jennifer R. Bellon, Eric
P. Winer
From the Departments of Medical Oncology and Radiation
Oncology, Dana-Farber Cancer Institute; Brigham and Women's Hospital; and
Harvard Medical School, Boston, MA. Address reprint requests to Eric P. Winer, MD, Dana-Farber Cancer
Institute, 44 Binney St, Boston, MA 02115; e-mail: ewiner@partners.org
As systemic therapy of metastatic breast cancer improves, CNS involvement
is becoming a more widespread problem.
This article summarizes the
current knowledge regarding the incidence, clinical presentation,
diagnosis, prognosis, and treatment of CNS metastases in patients
with breast cancer.
When available, studies specific to breast cancer
are presented; in studies in which many solid tumors were evaluated
together, the proportion of patients with breast cancer is noted.
On
the basis of data from randomized trials and retrospective series,
neurosurgery and stereotactic radiosurgery (SRS) may prolong survival
in patients with single brain metastases.
The treatment of multiple
metastases remains controversial, as does the routine use of
whole-brain radiotherapy (WBRT) after either surgery or SRS.
Although
it is widely assumed that chemotherapy is of limited benefit, data
from case series and case reports suggest otherwise.
WBRT,
neurosurgery, SRS, and medical therapy each have a role in the
treatment of CNS metastases; however, neurologic symptoms frequently
are not fully reversible, even with appropriate therapy.
Studies
specifically targeted toward this group of patients are needed.
Supported in part by the National Cancer Institute Specialized
Program of Research Excellence in Breast Cancer.
© 2004 American Society of Clinical Oncology
Source: http://www.jco.org/cgi/content/abstract/22/17/3608
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