CNS metastasis in primary breast cancer

The development of CNS metastasis in patients with solid malignancies represents a turning point in the disease process. The prevalence of CNS metastasis from breast cancer may be increasing due to improved systemic therapy for stage IV breast cancer. The standard treatment for multiple brain lesions remains whole-brain radiation for symptom control, with no improvement in survival. The therapy for a single brain metastasis remains either surgery or radiosurgery, with conflicting information as to the benefit of prior whole-brain radiation. The role of chemotherapy remains investigational in this setting. Leptomeningeal metastasis is conventionally treated with intrathecal chemotherapy, but may provide short-term symptom control. This review focuses on the treatment options available for both brain and leptomeningeal metastasis from breast cancer, including some investigational therapies that may be of importance in patient management in the near future.