[Lani]

tiny is the suggestion of the conclusion of the article.

This article reports significant results, and is not even limited to her2+ bc brain mets, which tend to do better than her2-brain mets which are usually triple negative

Of course it will take more and larger studies to change standard-of-care, if it is warranted. It may also depend on access to and expertise with SRS in any particular geographic area. It will be interesting to see if the requirements for recommending one over the other change and perhaps the recommendation may differ in the end for those that are her2+ and those that are not



Neurosurg. 2010 Oct 1. [Epub ahead of print]
Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer.
Kondziolka D, Kano H, Harrison GL, Yang HC, Liew DN, Niranjan A, Brufsky AM, Flickinger JC, Lunsford LD.

Departments of Neurological Surgery.
Abstract
Object To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival. Methods The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19–84 years), and the median number of tumors per patient was 2 (range 1–18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm³ (range 0.01–48.9 cm³), and the median total tumor volume for each patient was 4.9 cm³ (range 0.09–74.1 cm³). Results Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable. Conclusions Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.

PMID: 20887087