Brain metastasis in breast cancer

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Breast cancer

 With the advancement of breast cancer diagnosis and treatment, the survival time of breast cancer patients has prolonged significantly, but the incidence of breast cancer brain metastases (BCBM) has gradually increased. This article reviews recent clinical studies related to the survival prognosis and treatment of breast metastases from breast cancer. It is generally believed that factors such as age, KPS score, receptor status, number of brain metastases, and control of extracranial lesions affect patient prognosis. Surgery, whole brain radiotherapy (WBRT), and stereotactic radiosurgergy (SRS) are currently the first-line treatments for brain metastases. With the development of comprehensive breast cancer treatment, the application of chemotherapy and molecular targeted therapy in breast metastasis has received more and more attention. 


Brain metastasis of breast cancer

 In recent years, with the continuous improvement of diagnosis and treatment, the survival time of patients has prolonged significantly, and the incidence of brain metastases (brain metastasis, BM) has also increased significantly. About 30% of patients will eventually develop brain metastases, and the survival time after brain metastases is 2 ~ 14 months. Breast cancer has a high incidence of brain metastasis and a poor prognosis. It has become an important factor affecting quality of life and survival. The prognosis and treatment of BM has always been the focus and difficulty of academic circles. It is important to analyze its clinical characteristics and find effective treatments. And urgent task. This article reviews the clinical prognosis and treatment of BCBM. 


Prognostic factors for brain metastases from breast cancer

Some studies have shown that the prognosis of BCBM is related to factors such as age, molecular classification, extracranial metastasis, number of BM lesions, maximum lesion area, and KPS score. Researchers have established different prognostic evaluation models based on the above influencing factors, trying to more effectively distinguish patients with different prognostic brain metastases to help the choice of clinical strategies. 


Treatment of brain metastatic breast cancer

 The treatment of brain metastases from breast cancer must be comprehensively evaluated based on factors such as the general condition of the patient, the location of the lesion, and extracranial control before deciding the treatment plan. At present, surgery, WBRT, and SRS are still the first-line treatment of BCBM. Progress has also been made in chemotherapy and molecular targeted therapies. 


Hormone therapy for metastatic breast cancer

 The commonly used drug is dexamethasone, and hormone therapy is not required for patients with asymptomatic brain metastases. Dexamethasone can relieve the symptoms caused by edema in a short time by restoring the elasticity of arterial blood vessels and reducing the permeability of capillaries. The recommended starting dose of dexamethasone is 4 ~ 8mg / d; when brain metastases are secondary to severe cerebral edema and high intracranial pressure, it is recommended to use dexamethasone at a dose of 16mg / d or greater, which should be gradually reduced when discontinued. the amount. 


Surgical treatment of metastatic breast cancer

 It is mainly suitable for patients with single shots and KPS> 70. Clinically, 20% -30% of patients are suitable for surgical treatment. Its advantages are that it can quickly relieve symptoms, obtain pathological specimens, and improve local control rate. The status of surgery in multiple brain metastases is still lacking relevant data and conclusions. 


Whole brain radiotherapy

 For patients with intracranial lesions> 3, the total effective rate of whole-brain radiotherapy alone was 60 to 80%. About 70% of patients had improved symptoms and prolonged the average survival time of 3 to 6 months. Stereotactic Radiosurgery (SRS)It is generally believed that SRS is mainly suitable for patients with 3 or less lesions, a diameter of <3.0 cm, and a small space effect, especially for tumors that are not easily accessible during surgery and are located in important functional areas. But SRS has been studied more and more in multiple brain metastases, and it seems feasible. 


Chemotherapy for metastatic breast cancer

 The efficacy of chemotherapy on BCBM is limited because the drug has difficulty crossing the blood-brain barrier. Some studies in recent years have shown that the combination of chemotherapy and radiotherapy can improve the efficacy. Because radiation therapy opens the blood-brain barrier, drugs can enter the skull to exert anti-tumor effects. Although chemotherapeutic drugs are difficult to achieve a clear antitumor effect in the skull, effective control of extracranial lesions can improve the quality of life and prolong the survival time of patients. 


Targeted therapy for metastatic breast cancer 

 With the continuous understanding of the mechanism of tumor formation and metastasis, molecular targeted therapy has become a routine treatment strategy for malignant tumors. Bevacizumab combined with radiotherapy is mainly used for the treatment of gliomas, and there are few studies in brain metastases such as breast cancer and lung cancer, and further research is still needed. 


Endocrine therapy for metastatic breast cancer

 There is very little research data on endocrine therapy in BCBM treatment. Because endocrine therapy has a slower onset of action, and most patients with BM have a poor prognosis and need to control local symptoms as soon as possible, endocrine therapy is not recommended as first-line treatment for BCBM. In summary. The high incidence and poor prognosis of brain metastases in breast cancer have become clinically difficult problems. It is generally believed that factors such as age, KPS score, receptor status, number of brain metastases, and stability of extracranial lesions affect the prognosis of patients, but the current prognostic assessment model has limited predictive power and needs to be further improved and improved. In terms of treatment, surgery and radiation therapy are still the main treatment methods, and the status of chemotherapy and molecular targeted drugs has gradually increased.


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