Palliative radio-chemotherapy with ifosfamide and BCNU for breast cancer patients with cerebral metastases. A 5-year experience.

Between January 1983 and April 1989, 61 patients with brain metastases of primary breast cancer were treated in the Robert Janker Clinic. To optimize the overall response rates, a simultaneous combination of radiation and chemotherapy was used. The patients median age was 49 (range, 30-67) years and the median performance score, 1 (0-2). The average interval between the diagnosis of the primary tumour and the brain metastases was 38 (range, 3-144) months. A total of 82% of the patients had multiple cerebral metastases. All patients had been pretreated with primary surgery; 79%, with radiation; 74%, with chemotherapy; and 64%, with hormones. Radiotherapy was given using a cobalt 60 machine. The whole brain was irradiated in daily fractions of 1.5 Gy, up to a total dose of 45 Gy. Using a split-course technique, this dose was given in three courses simultaneously with the chemotherapy. The chemotherapeutic regimen consisted of ifosfamide given daily for 5 days at 2 g/m2 and the nitrosourea derivative carmustine (BCNU) given at 30 mg/m2 on 3 days. The toxicity of the treatment was moderate; no haemotological or gastro-intestinal complications occurred. Complete and mostly irreversible alopecia occurred in all cases. All patients received a cranial computerized tomographic (CT) scan prior to and after treatment. According to the criteria of the International Union Against Cancer (UICC), there was a complete remission (CR) in 20% of the patients and a partial remission (PR) in 45%; 20% had a minor remission (MR) and 7% showed no change (NC) in the tumour. Another 7% of the patients experienced a progression of their metastases (PD). The median survival was 8 months for all patients and 12 months for those showing a CR.