BRAIN METASTASES IN BREAST-CANCER - NATURAL-HISTORY, PROGNOSTIC FACTORS AND OUTCOME

One hundred and thirty seven breast cancer patients with CT scan docum ented brain metastasis (BM) were reviewed. Occurrence of brain as firs t site of relapse was associated with adjuvant systemic therapy of the primary tumor. Multivariate analysis showed significantly longer surv ival in patients without manifest systemic disease, in patients with a solitary BM, in those with neurologic symptoms present for more than 4 weeks prior to diagnosis, and in those treated with chemotherapy aft er diagnosis. When controlling for prognostic factors no significant d ifference in survival was found between surgery and radiotherapy (RT) as treatment of a solitary lesion. Tumor size, tumor necrosis and mass effect had no demonstrable influence on survival. Overall median surv ival was 16 weeks and 19% survived one year. Neurologic disease was th e cause of death or a major contributing factor to it in 68% of the pa tients, indicating the need for improvement of the treatment of BM its elf. These results warrant further studies on the value of surgery, RT and chemotherapy in solitary as well as multiple BM from breast carci noma.