Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift
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 (S...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/6/1514 |
| _version_ | 1797446927210512384 |
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| author | Edy Ippolito Sonia Silipigni Paolo Matteucci Carlo Greco Sofia Carrafiello Vincenzo Palumbo Claudia Tacconi Claudia Talocco Michele Fiore Rolando Maria D’Angelillo Sara Ramella |
| author_facet | Edy Ippolito Sonia Silipigni Paolo Matteucci Carlo Greco Sofia Carrafiello Vincenzo Palumbo Claudia Tacconi Claudia Talocco Michele Fiore Rolando Maria D’Angelillo Sara Ramella |
| author_sort | Edy Ippolito |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T13:48:29Z |
| format | Article |
| id | doaj.art-cd921e56febe4ab8a5181abbc0e6a8dc |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T13:48:29Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-cd921e56febe4ab8a5181abbc0e6a8dc2023-11-30T20:56:29ZengMDPI AGCancers2072-66942022-03-01146151410.3390/cancers14061514Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm ShiftEdy Ippolito0Sonia Silipigni1Paolo Matteucci2Carlo Greco3Sofia Carrafiello4Vincenzo Palumbo5Claudia Tacconi6Claudia Talocco7Michele Fiore8Rolando Maria D’Angelillo9Sara Ramella10Radiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyRadiation Oncology, Tor Vergata University, 00133 Rome, ItalyRadiation Oncology, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, ItalyBrain 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.https://www.mdpi.com/2072-6694/14/6/1514brain metastasesstereotactic radiotherapyHER2+multimodal treatmentradiosensitizationside effects |
| spellingShingle | Edy Ippolito Sonia Silipigni Paolo Matteucci Carlo Greco Sofia Carrafiello Vincenzo Palumbo Claudia Tacconi Claudia Talocco Michele Fiore Rolando Maria D’Angelillo Sara Ramella Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift Cancers brain metastases stereotactic radiotherapy HER2+ multimodal treatment radiosensitization side effects |
| title | Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift |
| title_full | Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift |
| title_fullStr | Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift |
| title_full_unstemmed | Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift |
| title_short | Radiotherapy for HER 2 Positive Brain Metastases: Urgent Need for a Paradigm Shift |
| title_sort | radiotherapy for her 2 positive brain metastases urgent need for a paradigm shift |
| topic | brain metastases stereotactic radiotherapy HER2+ multimodal treatment radiosensitization side effects |
| url | https://www.mdpi.com/2072-6694/14/6/1514 |
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