Unanswered questions

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.