Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer. Clinical article

J Neurosurg. 2011 Mar;114(3):792-800. doi: 10.3171/2010.8.JNS10461. Epub 2010 Oct 1.


Object: To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival.

Methods: The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19-84 years), and the median number of tumors per patient was 2 (range 1-18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm(3) (range 0.01-48.9 cm(3)), and the median total tumor volume for each patient was 4.9 cm(3) (range 0.09-74.1 cm(3)).

Results: Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable.

Conclusions: Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents / therapeutic use
  • Brain Edema / prevention & control
  • Brain Neoplasms / mortality
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery*
  • Breast Neoplasms / genetics
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology*
  • Female
  • Follow-Up Studies
  • Genes, erbB-2 / genetics
  • Humans
  • Kaplan-Meier Estimate
  • Karnofsky Performance Status
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Prognosis
  • Radiosurgery / methods*
  • Salvage Therapy*
  • Survival Analysis
  • Treatment Outcome
  • Watchful Waiting


  • Anti-Inflammatory Agents
  • Methylprednisolone