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Purpose: To investigate treatment options for local control of metastasisin the brain, we compared focal brain treatment (FBT)with or without whole brain radiotherapy (WBRT) vs. WBRT alone,for breast cancer patients with tumor relapse in the brain. We alsoevaluated treatment outcomes according to the subtypes. Methods:We conducted a retrospective review of breast cancer patientswith brain metastasis after primary surgery. All patients receivedat least one local treatment for brain metastasis. Surgeryor stereotactic radiosurgery was categorized as FBT. Patientswere divided into two groups: the FBT group received FBT±WBRT, whereas the non-FBT group received WBRT alone. Subtypeswere defined as follows: hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HRpositive/HER2-positive, HR-negative/HER2-positive, and triplenegative(TN). We examined the overall survival after brain metastasis(OSBM), brain metastasis-specific survival (BMSS), andbrain metastasis-specific progression-free survival (BMPFS). Results:A total of 116 patients were identified. After a median follow-up of 50.9 months, the median OSBM was 11.5 months(95% confidence interval, 9.0–14.1 months). The FBT groupshowed significantly superior OSBM and BMSS. However, FBTwas not an independent prognostic factor for OSBM and BMSSon multivariate analyses. In contrast, multivariate analysesshowed that patients who underwent surgery had improvedBMPFS, indicating local control of metastasis in the brain. FBTresulted in better BMPFS in patients with HR-negative/HER2-positive cancer or the TN subtype. Conclusion: We found that patientswho underwent surgery experienced improved local controlof brain metastasis, regardless of its extent. Furthermore, FBTshowed positive results and could be considered for better localcontrol of brain metastasis in patients with aggressive subtypessuch as HER2-positive and TN.

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