RANKING OF RADIOTHERAPY AND SURGERY IN TH E TREATMENT OF BRAIN METASTASES FROM BREAST-CANCER

In a group of 45 patients who had been conventionally irradiated, a mu ltivariate analysis of prognostic factors was performed to find criter ia for patient selection for surgery and radiotherapy or radiotherapy only. Nine patients underwent resection of metastases before irradiati on. In most cases 10 x 3 Gy over 2 weeks were administered. 28 patient s received concomitant hormonal treatment. Complete remission was seen in 30% of the non-operated cases (partial remission 25%). Symptomatic relief was seen in 67% of all cases. Median survival was 4 months (9. 5 months after surgery) (p = 0.02). Survival of patients having had si multaneous extracerebral metastases and low Karnofsky performance stat us was disappointing. Ah long-time survivors received either hormonal treatment or chemotherapy. Karnofsky performance status and interval b etween the diagnosis of the primary tumour and the development of brai n metastases were the most important prognostic factors. The influence of age and extracerebral metastases was less pronounced. In case of f avourable prognostic factors and solitary metastases surgical treatmen t should be considered. Primary irradiation seems to be appropriate fo r the majority of patients. In any case an additional hormonal or chem otherapy must be considered. It seems to be questionable if patients w ith poor Karnofsky performance status and extracerebral metastases sho uld be irradiated.