Chemotherapy as primary treatment for brain metastases from breast cancer: Analysis of 115 one-year survivors

Purpose: Given the potential toxicity of whole brain radiotherapy, we introduced systemic therapy as possible primary treatment for brain metastases (BM) from breast cancer. This study aims to evaluate the feasibility of this therapeutic approach. Methods: Review of 115 breast cancer patients treated for BM with at least 1 year of follow-up. Results: Patients with single BM without extracranial disease were usually treated with surgery, patients with multiple BM and controlled extracranial disease usually with RT, and those with progressive extracranial disease usually with systemic therapy as primary treatment for BM. Primary treatment for BM was surgery in 30 patients, RT in 26 patients, RT combined with systemic therapy in 33 patients, and systemic therapy as single treatment in 27 patients (chemotherapy n = 20; hormonal therapy n = 7). Response rate to surgery was 100 %, to RT 85 %, to RT+systemic therapy 87 %, to chemotherapy 70 %, and to hormonal therapy 14 %. Duration of neurological response and of extracranial response to chemotherapy as single treatment was similar (8 and 7 months, respectively). Patients with single BM and patients without extracranial disease had a better survival but the difference was not significant. Conclusion: Chemotherapy as single treatment for BM from breast cancer is feasible and should not be restricted to salvage treatment.