Screening
Figure 1. Algorithm for Patients with HER2+ Metastatic
Breast Cancer with CNS Metastasis
Prognosis
Number of metastases
Symptomatic?
Suitable
for SRS?
Symptomatic?
Size
Patients who had not received prior treatment
Favorable prognosis
Patients with a single metastasis
Patients with a
metastasis >3–4 cm
Patients with a
metastasis <3–4 cm
No,
symptomatic
mass effect
No, without
symptomatic
mass effect
No,
unresectable
Yes
Yes,
symptomatic
mass effect
Patients with 2–4 metastases
SRS or surgical
resection or
upfront systemic
therapy
a
SRS ±
WBRT/
M-HA
SRS or
surgical
resection
a,b
WBRT/M-HA ±
subsequent SRS
If resection, then
postoperative
radiation therapy
(RT)
If resection, then
postoperative
radiation therapy
(RT)
