Management of central nervous system metastases in breast cancer

The cumulative incidence of brain metastasis at 5 years is approximately 5% in patients with breast cancer but is much higher in postmortem autopsy series. Overall breast cancer is the second most common cause of brain metastasis. Leptomeningeal metastatic disease is rarer at less than 1%. Metastatic epidural spinal cord compression preceding death due to breast cancer has been reported at 5.52%. Prompt diagnosis and treatment before the development of paralysis or paresis is associated with a better prognosis. Patients who present with cord compression without paresis can be adequately treated with radiation therapy (RT) alone (with or without corticosteroids). Patients who present with paresis or paralysis are less likely to regain neurologic function and have a worse prognosis. These patients require urgent evaluation and may be best treated with immediate decompression through surgery followed by postoperative RT.