Table 20. Treatment of breast cancer brain metastases.

Stratification	Level I recommendations	Level II recommendations
For patients presenting with a limited number of brain metastases	(I) Well-controlled extracranial disease, KPS ≥60 points	(I) SRT may be considered for lesions sized ≤3.5 cm (1B)
	(i) Surgical resection (1A); postoperative SRT to the resection cavity	(II) SRT may be considered for inoperable lesions (1B)
	(ii) Direct SRT for patients who do not need surgery or with biopsy-confirmed metastases	(III) Anti-HER2 therapy can be considered firstly in HER2-positive patients with controllable local symptoms (2A)
	(II) Poorly-controlled extracranial disease, with low KPS score	(IV) WBRT (with hippocampal avoidance)
	(i) Whole-brain radiotherapy (WBRT) (2A)
	(ii) Supportive care (2A)
For patients with diffuse brain metastases	WBRT (with hippocampal avoidance) (1A)	Anti-HER2 therapy can be considered firstly in HER2-positive patients with controllable local symptoms (2A)
Meningeal metastasis	Radiotherapy (2A)	Intrathecal injection (2B)

SRT, stereotactic radiotherapy; WBRT, Whole-brain radiotherapy.