Questionnaire Survey of Treatment Choice for Breast Cancer Patients with Brain Metastasis in Japan: Results of a Nationwide Survey by the Task Force of the Japanese Breast Cancer Society

Objective: A nationwide survey was performed to investigate the currentpatterns of care for brain metastasis (BM) from breast cancerin Japan. Method: A total of 351 survey questionnaires were sent to communityor academic breast oncologists who were members of the JapaneseBreast Cancer Society as of December 2005. The questionnaireconsists of 40 multiple choice questions in eight categories. Results: Of 240 institutions sent survey questionnaires, 161 (67.1%)answered; 60% of institutions answered with ‘<5’patients with BM every year; almost half (83 of 161) screenedfor BM in asymptomatic patients; surgical resection was rarelyperformed, as ~75% of institutions (118 of 160 institutions)answered ‘none or one case of surgery per year’;27% (41 of 154) preferred stereotactic radiosurgery (SRS) overwhole-brain radiotherapy (WBRT) as the initial treatment inall cases, although ~70% (100 of 154) of them answered ‘dependon cases’. The preference for SRS over WBRT mainly dependson the impressions of breast oncologists about both safety (latenormal tissue damage and dementia in WBRT) and efficacy (betterlocal control by SRS). Eighty-one percent (117 of 144) of institutionsdid not limit the number of SRS sessions as far as technicallyapplicable. Conclusion: SRS is widely used as the first choice for BM from breast cancerin Japan. Considerable numbers of Japanese breast oncologistsprefer SRS over WBRT as the initial treatment for BM. A randomizedtrial comparing SRS and WBRT is warranted.