Patients with HER2+ metastatic
breast cancer with CNS metastasis
Received prior
treatment?
Resectable?
Suitable
for SRS?
Symptomatic?
Symptomatic?
Poor prognosis
No, symptomatic mass
effect
Patients with ≥5 metastases
Yes
No
Yes
No
Yes,
resectable
No
BSC, palliative care ±
radiation
therapy
a
WBRT/M-HA or SRS if <2 cm without
symptoms, potential systemic therapy
a
WBRT/M-
HA ±
subsequent
SRS or
systemic
therapy
a
Resection
(of larger lesion)
+ postoperative
RT or SRS ±
WBRT (for small
symptomatic,
resectable
metastasis)
SRS ±
WBRT/M-HA
or systemic
therapy
a
SRS ± WBRT/M-HA
