ArticleBreast cancer research and treatment2026
Brain-only metastatic breast cancer as a distinct clinical entity: evidence from national and institutional cohorts with implications for radiation therapy.
Article in Breast cancer research and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeBrain-only metastatic breast cancer (BO-MBC), defined as breast cancer with brain metastases (BrM) in the absence of extracranial metastatic disease (ECM), may represent a distinct metastatic phenotype. We characterized clinicopathologic features, treatment patterns, and outcomes of BO-MBC and evaluated associations between metastatic pattern, treatment, and survival.
methodsPatients with isolated BrM at our institution were evaluated for intracranial progression-free survival (iPFS), extracranial progression-free survival (ePFS), leptomeningeal disease-free survival (LMD-PFS), and overall survival (OS). Patients with MBC diagnosed between 2010 and 2020 were identified from the NCDB and classified as BO-MBC or BrM with concurrent ECM (BrM + ECM). Overlap propensity score-weighted Cox models evaluated associations between metastatic pattern, treatment, and OS.
resultsIn the institutional cohort (n = 30), intracranial progression was the predominant pattern of failure, with median iPFS of 14.6 months versus ePFS of 30.4 months. In the NCDB cohort (n = 8,909), 1,540 patients (17.3%) had BO-MBC. Compared with BrM + ECM, BO-MBC was associated with node-negative, triple-negative, and fewer HR+/HER2- disease (p < 0.001). BO-MBC patients were more likely to receive brain radiotherapy (54.8% vs. 41.0%, p < 0.001) but less likely to receive systemic therapy (67.2% vs. 74.5%, p < 0.001). In unadjusted Kaplan-Meier analyses, BO-MBC was associated with longer median OS than BrM + ECM (12.5 months [95% CI, 3.6-43.6] vs. 10.6 months [95% CI, 2.6-33.8]). Systemic therapy was associated with improved OS, with the greatest benefit in BO-MBC (adjusted HR 0.22, 95%CI 0.18-0.27). Brain radiotherapy was associated with improved OS in BO-MBC but not BrM + ECM.
conclusionsBO-MBC may represent a distinct clinical subgroup with unique clinicopathologic characteristics, treatment patterns, and improved survival. Intracranial progression predominated despite durable extracranial control, supporting optimized brain-directed management and prospective investigation of BO-MBC as a unique metastatic phenotype. CLINICAL TRIAL NUMBER: Not applicable.
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