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  • Review Article
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Whole-brain radiation therapy in breast cancer patients with brain metastases

Nature Reviews Clinical Oncology volume 7, pages 632–640 (2010)Cite this article

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Abstract

Over the past 10 years, improving the outcome of breast cancer patients with brain metastases has become an important challenge. The suboptimal results of whole-brain radiation therapy (WBRT) in these patients have led to the development of irradiation modalities with new technical and biological approaches. By ensuring better sparing of critical organs such as the hippocampus, highly conformal irradiation therapy may partially preserve long-term neurocognitive functions. An additional radiation boost to the tumor bed improves local control. Radiosensitizing agents and radioprotectors that modify response to radiation have also been designed to improve the efficacy of treatment or prevent neurological toxicity. This Review outlines the current strategies and novel developments in WBRT, with a particular focus on new irradiation modalities and experiences of radiosensitization.

Key Points

  • Whole-brain radiation therapy remains the standard treatment for breast cancer patients with four or more brain metastases

  • Age, number of brain metastases, controlled primary tumor, and performance status are important prognostic factors; molecular features should also be considered for predicting prognosis in patients with breast cancer

  • Delivering a radiation boost to the tumor bed could improve local control in selected patients, but improvements in overall survival have not been established

  • Intensity-modulated radiation therapy allows sparing of critical organs, such as the hippocampus, but its benefits have not yet been validated

  • Undifferentiated chemoradiation approaches have shown no conclusive benefit, but innovative strategies that target specific molecular subsets are encouraged

  • Radioprotectors designed to prevent neurological toxicity, such as amifostine, have not yet demonstrated clinical benefit

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Change history

  • 19 July 2010

    In the version of this article initially published online, there was a mistake in section two in Box 1, and the order of some of the references cited in the text, box, tables and reference list was incorrect. The errors have been corrected in all electronic versions of the text.

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Authors and Affiliations

  1. Medical and Radiation Oncology Unit Hôpital d'Instruction des Armées du Val-de-Grâce, 74 Boulevard de Port Royal, Paris Cedex 5, 75230, France

    Cyrus Chargari, Lionel Védrine & Sylvestre Le Moulec

  2. Neurology Unit Hôpital d'Instruction des Armées du Val-de-Grâce, 74 Boulevard de Port Royal, Paris Cedex 5, 75230, France

    Damien Ricard

  3. Department of Medical Oncology, Institut Curie, 26 rue d'Ulm, Paris Cedex 5, 75248, France

    Jean-Yves Pierga

  4. Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, Paris Cedex 5, 75248, France

    François Campana, Alain Fourquet & Youlia M. Kirova

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C. Chargari and Y. M. Kirova prepared the outline for the manuscript and wrote the content. All authors contributed to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

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Chargari, C., Campana, F., Pierga, JY. et al. Whole-brain radiation therapy in breast cancer patients with brain metastases. Nat Rev Clin Oncol 7, 632–640 (2010). https://doi.org/10.1038/nrclinonc.2010.119

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