Brain metastases in breast cancer: Prognostic factors and management

In this retrospective study, 162 breast cancer patients were analysed in wh om brain metastases had been diagnosed clinically between 1969 and 1995 at a single institution. 145 patients were treated with megavoltage irradiatio n (60 cobalt or 6 MV) of the whole brain using opposed fields. The most com mon applied schedule consisted of 30 Gy in 15 daily fractions over 3 weeks. 10 patients underwent surgery and 17 patients received symptomatic treatme nt only. The median age was 50 years (range 30-78 years). 81 of 162 patient s (50%) were premenopausal. Women younger than 40 years of age had a shorte r survival (median 12 weeks) than those of all other groups (median 29 week s). Median survival was 82 weeks for the 10 surgical patients, 26 weeks for the 145 patients treated with radiotherapy and 5 weeks for the patients wh o received symptomatic (corticosteroid) therapy only. Patients with solitar y metastases treated with radiation alone (45 patients) had a survival of 4 4 weeks versus 23 weeks in patients with multiple brain metastases. Multiva riate stepwise regression analyses revealed Karnofsky Index, dose of radiat ion (P < 0.001), solitary metastases (P < 0.04) and primary tumour size (P< 0.04) as significant prognostic factors for survival. (C) 1999 Elsevier Sc ience Ltd. All rights reserved.