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Abstract：
OBJECTIVE: The aim of this review was to evaluate the existing evidence for radiotherapy for brain metastases in breast cancer patients and provide recommendations for the use of radiotherapy for brain metastases and leptomeningeal carcinomatosis.
METHODS: For the current review, a PubMed search was conducted including articles from 01/1985 to 05/2023. The search was performed using the following terms: (brain metastases OR leptomeningeal carcinomatosis) AND (breast cancer OR breast) AND (radiotherapy OR ablative radiotherapy OR radiosurgery OR stereotactic OR radiation).
CONCLUSIONS: Despite the fact that the biological subtype of breast cancer influences both the occurrence and relapse patterns of breast cancer brain metastases (BCBM), for most scenarios, no specific recommendations regarding radiotherapy can be made based on the existing evidence. For a limited number of BCBM (1-4), stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SRT) is generally recommended irrespective of molecular subtype and concurrent/planned systemic therapy. In patients with 5-10 oligo-brain metastases, these techniques can also be conditionally recommended. For multiple, especially symptomatic BCBM, whole-brain radiotherapy (WBRT), if possible with hippocampal sparing, is recommended. In cases of multiple asymptomatic BCBM (≥ 5), if SRS/SRT is not feasible or in disseminated brain metastases (> 10), postponing WBRT with early reassessment and reevaluation of local treatment options (8-12 weeks) may be discussed if a HER2/Neu-targeting systemic therapy with significant response rates in the central nervous system (CNS) is being used. In symptomatic leptomeningeal carcinomatosis, local radiotherapy (WBRT or local spinal irradiation) should be performed in addition to systemic therapy. In patients with disseminated leptomeningeal carcinomatosis in good clinical condition and with only limited or stable extra-CNS disease, craniospinal irradiation (CSI) may be considered. Data regarding the toxicity of combining systemic therapies with cranial and spinal radiotherapy are sparse. Therefore, no clear recommendations can be given, and each case should be discussed individually in an interdisciplinary setting.
METHODS: For the current review, a PubMed search was conducted including articles from 01/1985 to 05/2023. The search was performed using the following terms: (brain metastases OR leptomeningeal carcinomatosis) AND (breast cancer OR breast) AND (radiotherapy OR ablative radiotherapy OR radiosurgery OR stereotactic OR radiation).
CONCLUSIONS: Despite the fact that the biological subtype of breast cancer influences both the occurrence and relapse patterns of breast cancer brain metastases (BCBM), for most scenarios, no specific recommendations regarding radiotherapy can be made based on the existing evidence. For a limited number of BCBM (1-4), stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (SRT) is generally recommended irrespective of molecular subtype and concurrent/planned systemic therapy. In patients with 5-10 oligo-brain metastases, these techniques can also be conditionally recommended. For multiple, especially symptomatic BCBM, whole-brain radiotherapy (WBRT), if possible with hippocampal sparing, is recommended. In cases of multiple asymptomatic BCBM (≥ 5), if SRS/SRT is not feasible or in disseminated brain metastases (> 10), postponing WBRT with early reassessment and reevaluation of local treatment options (8-12 weeks) may be discussed if a HER2/Neu-targeting systemic therapy with significant response rates in the central nervous system (CNS) is being used. In symptomatic leptomeningeal carcinomatosis, local radiotherapy (WBRT or local spinal irradiation) should be performed in addition to systemic therapy. In patients with disseminated leptomeningeal carcinomatosis in good clinical condition and with only limited or stable extra-CNS disease, craniospinal irradiation (CSI) may be considered. Data regarding the toxicity of combining systemic therapies with cranial and spinal radiotherapy are sparse. Therefore, no clear recommendations can be given, and each case should be discussed individually in an interdisciplinary setting.
摘要：
目的：本综述的目的是评估乳腺癌患者脑转移放疗的现有证据，并为脑转移和软脑膜癌放疗的使用提供建议。
方法：对于当前的审查，进行了PubMed搜索，包括1985年1月5日至2023年5月的文章。使用以下术语进行搜索：（脑转移或软脑膜癌）和（乳腺癌或乳腺癌）和（放疗或消融性放疗或放射外科或立体定向或放疗）。
结论：尽管乳腺癌的生物学亚型影响乳腺癌脑转移的发生和复发模式，对于大多数场景，根据现有证据,无法提出关于放疗的具体建议.对于有限数量的BCBM(1-4)，无论分子亚型和同步/计划的全身治疗如何,通常都推荐立体定向放射外科(SRS)或分次立体定向放射治疗(SRT).在5-10个寡脑转移的患者中，这些技术也可以有条件地推荐。对于多个，尤其是有症状的BCBM，全脑放射治疗（WBRT），如果可能的话，保留海马，是推荐的。在多个无症状BCBM（≥5）的情况下，如果SRS/SRT不可行或在播散性脑转移中（>10），如果使用在中枢神经系统(CNS)具有显著缓解率的HER2/Neu靶向全身治疗,则可以讨论通过早期重新评估和重新评估局部治疗方案(8~12周)来推迟WBRT.在症状性软脑膜癌病中，除全身治疗外,还应进行局部放疗(WBRT或局部脊柱照射).在临床状况良好且仅有限或稳定的中枢神经系统外疾病的播散性软脑膜癌病患者中，可以考虑颅脊髓照射（CSI）。关于全身疗法与颅脑和脊柱放射疗法相结合的毒性的数据很少。因此,没有明确的建议，每个案例都应该在跨学科的环境中单独讨论。
方法：对于当前的审查，进行了PubMed搜索，包括1985年1月5日至2023年5月的文章。使用以下术语进行搜索：（脑转移或软脑膜癌）和（乳腺癌或乳腺癌）和（放疗或消融性放疗或放射外科或立体定向或放疗）。
结论：尽管乳腺癌的生物学亚型影响乳腺癌脑转移的发生和复发模式，对于大多数场景，根据现有证据,无法提出关于放疗的具体建议.对于有限数量的BCBM(1-4)，无论分子亚型和同步/计划的全身治疗如何,通常都推荐立体定向放射外科(SRS)或分次立体定向放射治疗(SRT).在5-10个寡脑转移的患者中，这些技术也可以有条件地推荐。对于多个，尤其是有症状的BCBM，全脑放射治疗（WBRT），如果可能的话，保留海马，是推荐的。在多个无症状BCBM（≥5）的情况下，如果SRS/SRT不可行或在播散性脑转移中（>10），如果使用在中枢神经系统(CNS)具有显著缓解率的HER2/Neu靶向全身治疗,则可以讨论通过早期重新评估和重新评估局部治疗方案(8~12周)来推迟WBRT.在症状性软脑膜癌病中，除全身治疗外,还应进行局部放疗(WBRT或局部脊柱照射).在临床状况良好且仅有限或稳定的中枢神经系统外疾病的播散性软脑膜癌病患者中，可以考虑颅脊髓照射（CSI）。关于全身疗法与颅脑和脊柱放射疗法相结合的毒性的数据很少。因此,没有明确的建议，每个案例都应该在跨学科的环境中单独讨论。
