Important unanswered questions about the management of CNS metastases in women with metastatic breast cancer are outlined below. Some of these questions may be addressed in ongoing trials.
- The optimal timing of whole brain radiotherapy (WBRT) and local therapies, with outcomes relating to quality of life and overall survival.
- The efficacy of surgery alone compared to radiosurgery alone.
- The safety and effectiveness of hippocampal sparing techniques.
- The role of systemic therapies after radiotherapy in patients with triple negative breast cancer.
- Differences between isolated CNS metastases and wider/systemic metastases.
- The impact of brain metastases on quality of life, including changes in appearance, and the impact on carers.
- The efficacy of ‘active’ treatments compared to supportive and/or palliative care alone.
- Supportive care, including rehabilitation requirements, and palliative care needs for women with CNS metastases from breast cancer.
- Differences in approach to treatment based on subtype of breast cancer.