From the Guidelines
As a patient undergoing whole brain radiation therapy (WBRT) for metastatic breast cancer, you can expect a series of targeted treatments aimed at shrinking or controlling brain tumors, with potential side effects including fatigue, hair loss, skin irritation, headaches, and cognitive changes, as noted in the most recent guidelines 1. The treatment typically involves daily sessions of external beam radiation therapy, usually lasting 2-3 weeks. Each session is short, often 15-30 minutes, and painless during the actual radiation delivery. Side effects may include:
- Fatigue - This is common and can last for several weeks after treatment ends.
- Hair loss - In the areas where radiation is directed.
- Skin irritation - The scalp may become red, dry, or itchy.
- Headaches - Often manageable with over-the-counter pain relievers.
- Cognitive changes - Some patients experience short-term memory issues or difficulty concentrating. To manage these effects:
- Get plenty of rest
- Use gentle, fragrance-free shampoos and lotions on the scalp
- Wear a soft hat or scarf to protect the scalp
- Stay hydrated
- Inform your doctor of any severe symptoms The radiation works by damaging the DNA of cancer cells, preventing them from dividing and growing. While it also affects healthy cells, they are generally better able to repair this damage. Your oncologist may prescribe steroids like dexamethasone to reduce swelling in the brain. Follow their instructions carefully regarding dosage and tapering. Regular follow-up scans will be scheduled to monitor the treatment's effectiveness. Be prepared for potential adjustments to your treatment plan based on these results. It's essential to note that the approach to local therapy of brain metastases may differ in patients with HER2-positive breast cancer, and the management of leptomeningeal metastases is complex, as discussed in the guidelines 1. In terms of patient expectations, it's crucial to understand that WBRT can be associated with significant acute fatigue and neurocognitive sequelae, as highlighted in the American Society of Clinical Oncology clinical practice guideline 1. Overall, the goal of WBRT is to improve symptoms and quality of life, while also controlling the growth of brain tumors, as emphasized in the guidelines 1.
From the Research
Patient Expectations for Whole Brain Radiation Therapy (WBRT) in Metastatic Breast Cancer
- The primary goal of WBRT is to provide symptom relief and increase median and overall survival in patients with brain metastases from breast cancer 2.
- Patients with brain metastases from breast cancer can expect a median survival time of approximately 5-7.9 months after WBRT 3, 2.
- The treatment outcomes of WBRT can be influenced by various factors, including the presence of uncontrolled extracranial metastases, age, and the number of brain lesions 3, 4.
Factors Influencing Treatment Outcomes
- Uncontrolled extracranial metastases, except for bone metastases, and old age are significantly associated with a poor survival rate 3.
- The presence of HER2-positive disease is associated with improved overall survival 5, 4.
- The number of brain lesions at the time of diagnosis can also impact treatment outcomes, with patients having 1-3 brain lesions tend to have better outcomes than those with leptomeningeal disease or multiple lesions 4.
Treatment Strategies and Outcomes
- WBRT can provide initial response in approximately 82% of patients, but the duration of effect is limited with external beam irradiation alone 3.
- The addition of induction treatment with bevacizumab, etoposide, and cisplatin (BEEP) before WBRT may improve brain-specific progression-free survival compared to WBRT alone 5.
- The combination of neurosurgery and radiation therapy, including stereotactic radiosurgery (SRS) and WBRT, can be associated with improved overall survival in patients with brain metastases from breast cancer 4.