Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift

Cancers

Vincenzo Palumbo¹  Sofia Carrafiello¹  Paolo Matteucci¹  Claudia Talocco¹  Edy Ippolito¹  Claudia Tacconi¹  Sara Ramella¹  Michele Fiore¹  Sonia Silipigni¹  Carlo Greco¹  Rolando Maria D’Angelillo² 

[1] Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy;Radiation Oncology, Tor Vergata University, 00133 Rome, Italy;

关键词: brain metastases;    stereotactic radiotherapy;    HER2+;    multimodal treatment;    radiosensitization;    side effects;   

DOI  :  10.3390/cancers14061514

来源: DOAJ

【 摘 要 】

Brain metastases (BMs) are common among patients affected by HER2+ metastatic breast cancer (>30%). The management of BMs is usually multimodal, including surgery, radiotherapy, systemic therapy and palliative care. Standard brain radiotherapy (RT) includes the use of stereotactic radiotherapy (SRT) for limited disease and whole brain radiotherapy (WBRT) for extensive disease. The latter is an effective palliative treatment but has a reduced effect on brain local control and BM overall survival, as it is also associated with severe neurocognitive sequelae. Recent advances both in radiation therapy and systemic treatment may change the paradigm in this subset of patients who can experience long survival notwithstanding BMs. In fact, in recent studies, SRT for multiple BM sites (>4) has shown similar efficacy when compared to irradiation of a limited number of lesions (one to three) without increasing toxicity. These findings, in addition to the introduction of new drugs with recognized intracranial activity, may further limit the use of WBRT in favor of SRT, which should be employed for treatment of both multiple-site BMs and for oligo-progressive brain disease. This review summarizes the supporting literature and highlights the need for optimizing combinations of the available treatments in this setting, with a particular focus on radiation therapy.

【 授权许可】

Unknown