Brain metastases have a significant impact on quality of life and clinical outcomes of patients with cancer. Although the incidence of brain metastases in patients with breast cancer is low, brain metastases are relatively common in patients with metastatic breast cancer, particularly in patients with human epidermal growth factor receptor 2 (HER2)-positive or triple-negative breast cancer (TNBC) subtype. Despite the extracranial efficacy of many systemic therapies for patients with breast cancer, the bloodbrain barrier limits penetration of many systemic agents into the brain, and patients often experience intracranial progression. Therefore, radiation, in the form of whole brain radiotherapy (WBRT) or now more commonly stereotactic radiation, is the mainstay of the therapy for many patients with breast cancer and brain metastases. The management choice in patients with newly diagnosed brain metastases depends on number of brain metastasis, histological subtype, performance status, estimated prognosis, and extent of extracranial disease.
Thankfully brain radiation treatment has evolved over the past decade to lead to better outcomes for patients from a cancer perspective but also side effects and toxicities have been reduced. This article highlights two such developments.
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