Two questions were generated on this topic:
1. What is the survival rate for breast cancer patients with brain metastases versus breast cancer patients with no metastases?
Source: MD Anderson Manual of Medical Oncology. McGraw-Hill. 2006:Chapter 20.
5-year survival rate for metastatic breast cancer is 23%
versus 70% up to > 90% for local disease w/no evidence of axillary involvement
Source: UpToDate
5-year survival rate for metastatic breast cancer is 5-10%
citing older study (1996)
Source: Pubmed Clinical Query
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2. What is the functional and/or survival benefit of treating a patient with breast cancer that has metastasized to the brain with WBRT plus chemotherapy versus treating with only chemotherapy?
1. What is the survival rate for breast cancer patients with brain metastases versus breast cancer patients with no metastases?
Source: MD Anderson Manual of Medical Oncology. McGraw-Hill. 2006:Chapter 20.
5-year survival rate for metastatic breast cancer is 23%
versus 70% up to > 90% for local disease w/no evidence of axillary involvement
Source: UpToDate
5-year survival rate for metastatic breast cancer is 5-10%
citing older study (1996)
Source: Pubmed Clinical Query
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2. What is the functional and/or survival benefit of treating a patient with breast cancer that has metastasized to the brain with WBRT plus chemotherapy versus treating with only chemotherapy?
Searched Cochrane, EBM Reviews, Pubmed, Embase
Found a few RCTs comparing efficacy of WBRT+chemotherapy v. chemotherapy only. They are discussed in the Cochrane article below. Most RCTs compared WBRT alone or in combination w/systemic chemotherapy, radiosensitizing agents, or radiosurgery
***Source: Cochrane Library (searched: brain metasta* radi* )
Whole brain radiotherapy for the treatment of multiple brain metastases. Cochrane Database of Systematic Reviews 2006, Issue 3. (Should be able to see fulltext on campus)
Reviews RCTs comparing WBRT either alone or w/other treatments in adults with multiple metastases to the brain from any primary cancer. Some trials measured survival, while others also measured cognitive function and quality of life. Check out Authors' Conclusions and Discussion sections.
***Source: Pubmed Clinical Query (therapy, breast cancer AND brain metast* AND (radia* OR radio*))
Found a few RCTs comparing efficacy of WBRT+chemotherapy v. chemotherapy only. They are discussed in the Cochrane article below. Most RCTs compared WBRT alone or in combination w/systemic chemotherapy, radiosensitizing agents, or radiosurgery
***Source: Cochrane Library (searched: brain metasta* radi* )
Whole brain radiotherapy for the treatment of multiple brain metastases. Cochrane Database of Systematic Reviews 2006, Issue 3. (Should be able to see fulltext on campus)
Reviews RCTs comparing WBRT either alone or w/other treatments in adults with multiple metastases to the brain from any primary cancer. Some trials measured survival, while others also measured cognitive function and quality of life. Check out Authors' Conclusions and Discussion sections.
***Source: Pubmed Clinical Query (therapy, breast cancer AND brain metast* AND (radia* OR radio*))
Improved survival, quality of life, and quality-adjusted survival in breast cancer patients treated with efaproxiral (Efaproxyn) plus whole-brain radiation therapy for brain metastases. (This is further work from authors of earlier RCT reviewed in Cochrane Review above. )
This RCT includes only patients with breast cancer that has metastasized to the brain. One group received WBRT and the other received WBRT plus efaproxiral. It does show a statistically significant improvement in median survival time for the group receiving WBRT+efaproxiral, but the difference in the two measures is less than 5 months. Also, the drug can be very toxic. There is a table of hazard ratios for various subgroups in the article (Table
This RCT includes only patients with breast cancer that has metastasized to the brain. One group received WBRT and the other received WBRT plus efaproxiral. It does show a statistically significant improvement in median survival time for the group receiving WBRT+efaproxiral, but the difference in the two measures is less than 5 months. Also, the drug can be very toxic. There is a table of hazard ratios for various subgroups in the article (Table
This RCT explores differences in response to WBRT based on various prognostic factors. Shows useful criteria to consider in contemplating WBRT.
***Source: EMBASE, no information that was different from above
