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Brain Mets Breast SRS vs WBRT — SCE Medical Oncology MCQ

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ModerateBreast CancerBrain Mets Breast SRS vs WBRTSCE Medical Oncology

A 65-year-old woman with metastatic breast cancer develops brain metastases. Her systemic disease is ER+/HER2-. What is the role of SRS vs WBRT for breast cancer brain metastases?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — SRS is preferred for limited brain metastases (1-4 lesions, each ≤3-4 cm) to preserve neurocognitive function; WBRT is reserved for numerous/diffuse metastases; ER+ breast cancer brain metastases tend to have a more indolent course allowing repeated SRS approaches

SRS is preferred over WBRT for limited breast cancer brain metastases based on equivalent local control with superior neurocognitive outcomes. ER+ breast cancer brain metastases may follow a more indolent course than TNBC/HER2+ brain metastases, supporting a sequential SRS approach (treating new lesions as they appear). For HER2+ brain metastases, systemic anti-HER2 agents with CNS activity (tucatinib, T-DXd) complement local therapy. WBRT with hippocampal avoidance (HA-WBRT + memantine) is used for diffuse metastases.

Reference: NICE NG99; ESMO 2024 Brain Metastases; ESMO MBC