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Introduction: An increasing pool of literature proposes a link between silicone implants and autoimmune-related symptoms known colloquially as breast implant illness (BII). We describe the history of BII, reported symptoms, risk factors and previously published diagnostic criteria to aid clinicians in the diagnosis, investigations and management of patients presenting with symptoms that they attribute to their silicone breast implants. Methods: A literature search was performed using MEDLINE®, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effect (DARE) and PubMed in September 2018. The search terms ‘autoimmune inflammatory syndrome induced by adjuvants’, ‘breast implants’ and ‘silicone’ were used alone and in combination. Results: Thirty-four studies were reviewed including three case reports, 12 case series, 14 retrospective cohort studies, four case control studies and one prospective cohort study. Within this cohort, 18 studies were found regarding the explantation of implants relating to BII. Conclusion: Studies have demonstrated no association between silicone breast implants and any known autoimmune diseases, but there exists a pool of literature suggestive of a relatively undefined condition colloquially known as BII. Serological testing and imaging play an important role in the assessment of patients to exclude other pathology, but these tests remain non-diagnostic for BII. Although medical treatment has shown promise, there is no established treatment for patients. The surgical explantation of implants appears to have positive outcomes for patients; however, the exact nature of the surgery required to achieve this remains unclear.

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Background: The overall risk of developing brain metastases in non-small cell lung cancer (NSCLC) is 20%. Palliative chemotherapy improves the outcome of metastatic NSCLC but there is no evidence to support its use in the presence of brain metastases. A retrospective analysis of NSCLC patients with brain metastases was performed to determine the value of chemotherapy within this group of patients. Methods: Patients with NSCLC who received palliative whole brain radiotherapy (WBRT) for brain metastasis between January 2002 and April 2005 were identified from the radiotherapy database. Case notes and electronic records were analysed retrospectively. The primary endpoint was overall survival (OS) calculated from the date of confirmation of brain metastases and estimated using the Kaplan-Meier method. A multivariate analysis was performed using Cox regression to examine the effect of prognostic variables. Results: A total of 162 patients were identified. 87 patients (53.7%) had brain metastases at presentation. In addition to WBRT, 4 patients (2.5%) underwent surgical resection of brain metastases. 1 patient had stereotactic radiosurgery. 59 patients (36.4%) received chemotherapy following WBRT. The median number of cycles of chemotherapy administered following WBRT was 3 (range 1-6). Median OS was 3.84 months (95% CI 3.22 to 4.83 months) and 1 year survival 9.3%. Patients who were performance status (PS) 0-1 had a median OS of 6.47 months versus 2.63 months for those who were PS 2-3 (HR=2.08; 95% CI 1.48 to 2.92; p<0.0001). Patients receiving chemotherapy following WBRT had a median OS of 6.47 months versus 2.60 months for those who did not receive chemotherapy (HR=0.45; 95% CI 0.32 to 0.63; p<0.0001). In multivariate analysis, chemotherapy following WBRT remained a significant favourable prognostic factor after controlling for performance status, age, histological subtype, number and sites of brain metastases, synchronicity of brain metastases, dose of radiotherapy and presence of other distant metastases. Conclusion: Palliative chemotherapy following WBRT in patients with metastatic NSCLC with brain metastases improves survival and should be considered in good performance status patients.