CENTRAL-NERVOUS-SYSTEM METASTASIS IN BREAST-CANCER

Background and purpose. Central nervous system (CNS) metastasis occurs in at least 30% of patients with breast cancer. Standard treatment is the same as in other solid tumors, though clinical behavior, and sens itivity to radiation therapy (RT) and to chemotherapy may differ consi derably. Most of these patients die within a few months, but a substan tial subgroup may survive a year or more. The last decade has given ri se to new diagnostic methods, new surgical and radiotherapeutic techni ques, and the clinical evidence of a chemotherapy permissive blood-bra in barrier in CNS metastases. The literature was reviewed to assess th e clinical impact of early diagnosis, recognition of prognostic factor s, and of the recently developed therapeutic approaches. Material and methods. Review of the literature on CNS involvement in breast cancer focusing on clinical studies on early diagnosis, new modes of treatmen t, and factors influencing outcome. Results. Although randomized studi es are still awaited, systemic chemotherapy seems a valuable alternati ve for RT of brain metastases in selected cases. In meningeal carcinom atosis, long survival may be independent of intraventricular chemother apy. Neurotoxicity of intensive intraventricular treatment is consider able. In epidural metastasis, early diagnosis with prompt start of tre atment remains the crucial factor for outcome. Radiation therapy is th e mainstay of treatment of epidural metastasis, but new surgical techn iques and even systemic chemotherapy should be considered in selected cases. Conclusions. Recognition of prognostic factors combined with ap propriate use of various recently developed therapeutic possibilities will improve the clinical outcome including better local tumor control and less treatment-induced neurotoxicity in a considerable number of patients with CNS metastasis from breast cancer.