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Hypofractionated stereotactic radiation therapy showed high local control in breast cancer brain metastasesFSRT shows promising results for brain metastases in breast cancer patients

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Key Takeaway
Consider FSRT for breast cancer brain metastases, noting high local control but requiring confirmation in randomized trials.

This prospective single-arm phase 2 trial assessed the efficacy of fractionated stereotactic radiation therapy (FSRT) for brain metastases originating from breast cancer. The study enrolled 173 patients presenting with 1 to 10 brain lesions. Participants received FSRT delivered in 3 to 5 fractions of 8 Gy each. The median follow-up duration was 15 months.

Primary and secondary outcomes included local control, intracranial distant control, overall survival, and central nervous system progression-free survival. At one year, the local control rate was 88.6%. The intracranial distant control rate was 52.1% (95% CI, 44.7%-60.8%). Median overall survival was 29 months (95% CI, 21-35 months). Median central nervous system progression-free survival for patients with evaluable lesions was 12 months (95% CI, 9-16 months). Local control rates across all subtypes exceeded 86% at one year, and intracranial distant metastasis-free survival ranged from 39.7% to 57.9%.

Safety analysis revealed that 27 of 436 treated lesions (6.2%) experienced radiation necrosis. No grade 3 or 4 FSRT-related adverse events were observed. The study was conducted at a single institution. Key limitations include the single-arm design, which precludes comparative efficacy claims, and the single-institution setting, which may limit generalizability. Long-term outcomes beyond the median 15-month follow-up remain uncertain. Funding sources and conflicts of interest were not reported.

Researchers studied a specific type of radiation therapy called fractionated stereotactic radiation therapy (FSRT) for patients with breast cancer who had between one and ten lesions in their brains. The study included 173 patients treated at a single institution. The goal was to see how well the treatment kept the cancer in the brain under control and how long patients lived.

After a median follow-up of 15 months, the treatment showed a one-year local control rate of 88.6%. This means the cancer stayed controlled at the treated site in most patients. The study also found that median overall survival was 29 months, and the therapy was generally well-tolerated with no severe radiation-related side effects observed.

Safety data showed that 6.2% of treated lesions experienced radiation necrosis, a known risk of radiation therapy. Because this was a single-arm trial, there was no control group to compare against. Readers should understand that these findings are preliminary and need confirmation in larger, randomized trials before changing standard care.

The main takeaway is that this approach appears effective for this specific group, but it does not prove it is better than other options. More research is needed to fully understand long-term outcomes and how this treatment compares to existing therapies.

What this means for you:
FSRT showed high local control in a single-arm study, but results need confirmation in larger trials.

Study Details

Study typePhase2
Sample sizen = 173
EvidenceLevel 3
Follow-up15.0 mo
PublishedApr 2026
View Original Abstract ↓
PURPOSE: Although fractionated stereotactic radiation therapy (FSRT) remains understudied for the management of breast cancer brain metastases, this study aimed to investigate its therapeutic efficacy and safety in the context of contemporary systemic therapies. We enrolled patients with 1 to 10 brain lesions. METHODS AND MATERIALS: This was a prospective, single-arm, phase 2 trial involving 173 patients with breast cancer and 436 brain metastases, all treated with FSRT at a dose of 3 to 5 fractions of 8 Gy each. The primary endpoint was the local control rate, and secondary endpoints included the intracranial distant control rate, overall survival, and central nervous system progression-free survival. RESULTS: With a median follow-up of 15 months, the 1-year local control rate was 88.6% and the 1-year intracranial distant control rate was 52.1% (95% CI, 44.7%-60.8%). The median overall survival was 29 months (95% CI, 21-35 months), and the median central nervous system progression-free survival for patients with evaluable lesions was 12 months (95% CI, 9-16 months). Of the treated lesions, 27 out of 436 (6.2%) experienced radiation necrosis; no grade 3 or 4 FSRT-related adverse events were observed. Local control rates exceeded 86% at 1 year across all subtypes, whereas the intracranial distant metastasis-free survival was lower, ranging from 39.7% to 57.9%. CONCLUSIONS: In this single-institution trial, FSRT delivered in 3 to 5 fractions of 8 Gy each for breast cancer brain metastases yielded high local control with low rates of radiation necrosis in the background of modern systemic treatment.
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