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Higuchi R, Ono H, Matsuyama R, Takemura Y, Kobayashi S, Otsubo T, Abe Y, Endo I, Tanabe M, Yamamoto M. Examination of the characteristics of long-term survivors among patients with gallbladder cancer with liver metastasis who underwent surgical treatment: a retrospective multicenter study (ACRoS1406). BMC Gastroenterol 2022; 22:152. [PMID: 35346072 PMCID: PMC8962041 DOI: 10.1186/s12876-022-02234-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/23/2022] [Indexed: 12/30/2022] Open
Abstract
Background Gallbladder cancer (GBC) with liver metastasis is considered unresectable. However, there have been infrequent reports of long-term survival in patients with GBC and liver metastases. Therefore, we examined the characteristics of long-term survivors of gallbladder cancer with liver metastasis. Methods A retrospective multicenter study of 462 patients with GBC (mean age, 71 years; female, 51%) was performed. Although patients with pre-operatively diagnosed GBC and liver metastasis were generally excluded from resection, some cases identified during surgery were resected. Result In patients with resected stage III/IV GBC (n = 193), the period 2007–2013 (vs. 2000–2006, hazard ratio 0.63), pre-operative jaundice (hazard ratio 1.70), ≥ 2 liver metastases (vs. no liver metastasis, hazard ratio 2.11), and metastasis to the peritoneum (vs. no peritoneal metastasis, hazard ratio 2.08) were independent prognostic factors for overall survival, whereas one liver metastasis (vs. no liver metastasis) was not. When examining the 5-year overall survival and median survival times by liver metastasis in patients without peritoneal metastasis or pre-operative jaundice, those with one liver metastasis (63.5%, not reached) were comparable to those without liver metastasis (40.4%, 33.0 months), and was better than those with ≥ 2 liver metastases although there was no statistical difference (16.7%, 9.0 months). According to the univariate analysis of resected patients with GBC and liver metastases (n = 26), minor hepatectomy, less blood loss, less surgery time, papillary adenocarcinoma, and T2 were significantly associated with longer survival. Morbidity of Clavien–Dindo classification ≤ 2 and received adjuvant chemotherapy were marginally not significant. Long-term survivors (n = 5) had a high frequency of T2 tumors (4/5), had small liver metastases near the gallbladder during or after surgery, underwent minor hepatectomy without postoperative complications, and received postoperative adjuvant chemotherapy. Conclusions Although there is no surgical indication for GBC with liver metastasis diagnosed pre-operatively, minor hepatectomy and postoperative chemotherapy may be an option for selected patients with T2 GBC and liver metastasis identified during or after surgery who do not have other poor prognostic factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02234-9.
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Lacaze JL, Aziza R, Chira C, De Maio E, Izar F, Jouve E, Massabeau C, Pradines A, Selmes G, Ung M, Zerdoud S, Dalenc F. Diagnosis, biology and epidemiology of oligometastatic breast cancer. Breast 2021; 59:144-156. [PMID: 34252822 PMCID: PMC8441842 DOI: 10.1016/j.breast.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/01/2022] Open
Abstract
Does oligometastatic breast cancer (OMBC) deserve a dedicated treatment? Although some authors recommend multidisciplinary management of OMBC with a curative intent, there is no evidence proving this strategy beneficial in the absence of a randomized trial. The existing literature sheds little light on OMBC. Incidence is unknown; data available are either obsolete or biased; there is no consensus on the definition of OMBC and metastatic sites, nor on necessary imaging techniques. However, certain proposals merit consideration. Knowledge of eventual specific OMBC biological characteristics is limited to circulating tumor cell (CTC) counts. Given the data available for other cancers, studies on microRNAs (miRNAs), circulating tumor DNA (ctDNA) and genomic alterations should be developed Finally, safe and effective therapies do exist, but results of randomized trials will not be available for many years. Prospective observational cohort studies need to be implemented.
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Affiliation(s)
- Jean-Louis Lacaze
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France.
| | - Richard Aziza
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Imagerie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Ciprian Chira
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eleonora De Maio
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Françoise Izar
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eva Jouve
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Carole Massabeau
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Anne Pradines
- Institut Claudius Regaud (ICR), Département Biologie Médicale Oncologique, Centre de Recherche en Cancérologie de Toulouse, (CRCT), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), INSERM UMR-1037, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Gabrielle Selmes
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Mony Ung
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Slimane Zerdoud
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Médecine Nucléaire, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Florence Dalenc
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, Université de Toulouse, UPS, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
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Abstract
Historical theories of metastasis have been informed by the seed and soil hypothesis, the Halsteadian paradigm proposing an orderly spread from local to distant sites, and the presumption that cancer is an inherently systemic process even in the earliest cases. The more contemporary spectrum theory now suggests that the propensity for distant spread exists along a continuum of metastatic virulence. Tumors with limited metastatic potential represent one subset along this spectrum that could potentially be cured with local ablative therapy. Integrating clinical and molecular features to biologically inform the classification of not only oligometastatic or oligoprogressive disease but also the entire metastatic spectrum holds great promise to improve prognostication and inform clinical decision making. To this end, the inclusion of molecular correlative studies and biospecimen collection on prospective protocols is imperative.
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Jin P, Ji X, Tian Y. Surgical management of oligometastatic disease in gastric cancer. Clin Res Hepatol Gastroenterol 2020; 44:638-645. [PMID: 32147440 DOI: 10.1016/j.clinre.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
A distinctive subset of metastatic gastric cancer (MGC) is oligometastatic disease (OMD), which is characterized by metastatic lesions limited in number and location. Although growing evidence mainly based on retrospective analysis or single center case series has shown favorable prognosis in the management of OMD in gastric cancer with aggressive local treatment, no existing guidelines explicitely address the definition of OMD and there are still controversial opinions on how to proceed in a new era with more effective systemic therapy selection. In this review, we present the current advances and evidence as well as controversial on the management of OMD in MGC, including the definition, diagnosis, local aggressive treatments especially surgery, prognostic factors, current ongoing randomized clinical studied as well as challenges facing the field.
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Affiliation(s)
- Peng Jin
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China.
| | - Xiaoyan Ji
- Department of Emergency Ward, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China.
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Terata K, Imai K, Wakita A, Sato Y, Motoyama S, Minamiya Y. Surgical therapy for breast cancer liver metastases. Transl Cancer Res 2020; 9:5053-5062. [PMID: 35117871 PMCID: PMC8797688 DOI: 10.21037/tcr-20-1598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer in females worldwide. If diagnosed early, patients generally have good outcomes. However, approximately 20% to 30% of all women diagnosed with breast cancer develop metastatic disease. Metastatic breast cancer is incurable, but there is growing evidence that resection or other local therapy for breast cancer liver metastases (BCLM) may improve survival. We aimed to review indications for and outcomes of perioperative liver resection and other local therapies for BCLM. In this series, we reviewed 11 articles (605 patients) focusing on surgical resection and 7 articles (266 patients) describing radiofrequency ablation (RFA) for BCLM. Median disease-free survival (DFS) after surgical resection was 23 months (range, 14–29 months) and median overall survival (OS) was 39.5 months (range, 26–82 months). One, 3- and 5-year survivals were 89.5%, 70%, and 38%, respectively. The factors favoring better outcomes are hormone receptor positive primary breast cancer status, R0 resection, no extrahepatic metastases (EHM), small BCLM, and solitary liver metastases. On the other hand, the median DFS with RFA was 11 months, median OS was 32 months, and the 3- and 5-year OS were 43% and 27%, respectively. The clinical features that are indications for RFA are smaller tumor and higher EHM rate than those favoring surgical resection (2.4 vs. 4.0 cm and 46% vs. 27%). The merits of RFA are its high technical success rate, low morbidity, short hospital stay, and that it can be repeated. Although results are as yet limited, in carefully selected patients, resection or other local therapies such as RFA, render BCLM potentially provide prognostic improvement.
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Affiliation(s)
- Kaori Terata
- Department of Breast and Endocrine Surgery, Akita University Hospital, Akita, Japan.,Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Guru SD, Loprinzi CL, Yan E, Hoskin TL, Jakub JW. Contralateral Axillary Metastases in Breast Cancer: Stage IV Disease or a Locoregional Event? Am Surg 2020. [DOI: 10.1177/000313481908501235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contralateral axillary metastasis (CAM) in breast cancer is presently treated as a stage IV disease. We hypothesized that this disease pattern is a manifestation of direct aberrant lymphatic drainage and would behave more similar to advanced locoregional disease. This is a single-site, retrospective review of patients with biopsy-proven CAM from 2008–2017. Descriptive analysis was performed. Twenty-three patients met the inclusion criteria. The median disease-free interval from primary tumor treatment to diagnosis of CAM was 68 months (range, 36–155 months). This population had aggressive disease (74% local recurrences and 61% clinical evidence of cutaneous or underlying muscular invasion) and extensive locoregional therapy (70% radiated, 57% mastectomy, and 65% axillary lymph node dissection) before their presentation with CAM. Fifteen (65.2%) patients recurred after treatment of CAM; the median recurrence-free interval was 11 months (range, 5–23 months), and 12 (52.2%) patients developed distant metastases. The median distant metastasis-free survival was 14 months (range, 11–23 months), and the median overall survival was 31 months (range, 22–67.5 months). Development of CAM is associated with aggressive disease and extensive prior locoregional surgery and/or radiation. The short recurrence-free interval and high progression to additional stage IV disease suggest these patients behave similar to traditional stage IV patients with resected oligometastatic disease.
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Affiliation(s)
| | | | - Elizabeth Yan
- Radiation Oncology, Mayo Clinic, Rochester, Minnesota; and
| | - Tanya L. Hoskin
- Division of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Morino K, Seo S, Yoh T, Fukumitsu K, Ishii T, Taura K, Morita S, Kaido T, Uemoto S. Proposed Definition for Oligometastatic Recurrence in Biliary Tract Cancer Based on Results of Locoregional Treatment: A Propensity-Score-Stratified Analysis. Ann Surg Oncol 2020; 27:1908-1917. [PMID: 31939034 DOI: 10.1245/s10434-020-08207-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oligometastatic recurrence involves relapsed tumors for which locoregional treatment (LT) may yield a survival benefit. However, there are no clear criteria for selecting patients for LT or determining the effects of LT in recurrent biliary tract cancer (BTC). The aim of this retrospective study is to assess the effects of LT on survival outcomes and to identify potential criteria for selecting LT in recurrent BTC. PATIENTS AND METHODS In the present work, 232 consecutive patients with recurrent BTC who initially underwent curative surgery between 1996 and 2015 were evaluated. The primary outcome was length of survival after recurrence (SAR). Propensity score stratification with various tumor-related factors was used to identify patients who would likely benefit from LT. RESULTS Among the cohort, 60 (25.9%) patients underwent LT, whereas 172 (74.1%) patients did not. The multivariate Cox model identified carbohydrate antigen 19-9 levels of > 50 U/mL, multiorgan recurrence, tumor number > 3, tumor size > 30 mm, and early recurrence (≤ 1 year) as independent predictors of poor SAR (P < 0.001 for each factor). In the propensity-score-stratified analysis, LT was associated with survival benefits for patients representing single-organ recurrence with at most three tumors and late-onset recurrence (> 1 year) (median SAR: 48.6 vs. 14.2 months, n = 33 vs. n = 34, hazard ratio: 0.10, 95% confidence interval: 0.04-0.20, P < 0.001). CONCLUSIONS Patients with recurrent BTC may benefit from LT if they have single-organ recurrence with at most three tumors and late-onset recurrence. We propose that these patients may have clinically relevant "oligometastatic recurrence" of BTC.
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Affiliation(s)
- Koshiro Morino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tomoaki Yoh
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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8
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Lopez-Tarruella S, Escudero MJ, Pollan M, Martín M, Jara C, Bermejo B, Guerrero-Zotano A, García-Saenz J, Santaballa A, Alba E, Andrés R, Martínez P, Calvo L, Fernández A, Batista N, Llombart-Cussac A, Antón A, Lahuerta A, de la Haba J, López-Vega JM, Carrasco E. Survival impact of primary tumor resection in de novo metastatic breast cancer patients (GEICAM/El Alamo Registry). Sci Rep 2019; 9:20081. [PMID: 31882586 PMCID: PMC6934456 DOI: 10.1038/s41598-019-55765-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023] Open
Abstract
The debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. We explored this approach's outcomes in patients included in a retrospective registry, named El Álamo, of breast cancer patients diagnosed in Spain (1990-2001). In this analysis we only included de novo MBC patients, 1415 of whom met the study's criteria. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Median age was 63.1 years, 49.2% of patients had single-organ metastasis (skin/soft tissue [16.3%], bone [33.8%], or viscera [48.3%]). PT surgery (S) was performed in 44.5% of the cases. S-group patients were younger, had smaller tumors, higher prevalence of bone and oligometastatic disease, and lower prevalence of visceral involvement. With a median follow-up of 23.3 months, overall survival (OS) was 39.6 versus 22.4 months (HR = 0.59, p < 0.0001) in the S- and non-S groups, respectively. The S-group OS benefit remained statistically and clinically significant regardless of metastatic location, histological type, histological grade, hormone receptor status and tumor size. PT surgery (versus no surgery) was associated with an OS benefit suggesting that loco-regional PT control may be considered in selected MBC patients. Data from randomized controlled trials are of utmost importance to confirm these results.
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Affiliation(s)
- Sara Lopez-Tarruella
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - M J Escudero
- GEICAM, Spanish Breast Cancer Research Group, Madrid, Spain
| | - Marina Pollan
- Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - Carlos Jara
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Begoña Bermejo
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Hospital Clínico Universitario, Valencia. Biomedical Research Institute INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - José García-Saenz
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Emilio Alba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Complejo Hospitalario Virgen de la Victoria, Málaga, Spain
| | - Raquel Andrés
- Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Lourdes Calvo
- Complejo Hospitalario Juan Canalejo, A Coruña, Spain
| | | | | | | | - Antonio Antón
- Hospital General Universitario Miguel Servet, Zaragoza, Spain
| | | | - Juan de la Haba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Complejo Hospitalario Reina Sofía, Córdoba, Spain
| | | | - E Carrasco
- GEICAM, Spanish Breast Cancer Research Group, Madrid, Spain
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Zhang JT, Liu SY, Yan HH, Wu YL, Nie Q, Zhong WZ. Recursive partitioning analysis of patients with oligometastatic non-small cell lung cancer: a retrospective study. BMC Cancer 2019; 19:1051. [PMID: 31694572 PMCID: PMC6836326 DOI: 10.1186/s12885-019-6216-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background Local consolidative treatment (LCT) is important for oligometastasis, defined as the restricted metastatic capacity of a tumor. This study aimed to determine the effects and prognostic heterogeneity of LCT in oligometastatic non-small cell lung cancer. Methods This retrospective study identified 436 eligible patients treated for oligometastatic disease at the Guangdong Provincial People’s Hospital during 2009–2016. A Cox regression analysis was used to identify potential predictors of overall survival (OS). After splitting cases randomly into training and testing sets, risk stratification was performed using recursive partitioning analysis with a training dataset. The findings were confirmed using a validation dataset. The effects of LCT in different risk groups were evaluated using the Kaplan-Meier method. Results The T stage (p = 0.001), N stage (p = 0.008), number of metastatic sites (p = 0.031), and EGFR status (p = 0.043) were identified as significant predictors of OS. A recursive partitioning analysis was used to establish a prognostic risk model with the following four risk groups: Group I included never smokers with N0 disease (3-year OS: 55.6%, median survival time [MST]: 42.8 months), Group II included never smokers with N+ disease (3-year OS: 32.8%, MST: 26.5 months), Group III included smokers with T0–2 disease (3-year OS: 23.3%, MST: 19.4 months), and Group IV included smokers with T3/4 disease (3-year OS: 12.5%, MST: 11.1 months). Significant differences in OS according to LCT status were observed in all risk groups except Group IV (p = 0.45). Conclusions Smokers with T3/4 oligometastatic non-small cell lung cancer may not benefit from LCT.
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Affiliation(s)
- Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Qiang Nie
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Key Laboratory of Lung Cancer Translational Medicine, South China University of Technology & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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10
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Kleinclauss F, Thiery-Vuillemin A. [Oligometastatic prostate cancer management]. Prog Urol 2019; 29 Suppl 1:S20-S34. [PMID: 31307628 DOI: 10.1016/s1166-7087(19)30167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review biology and management of oligometastatic prostate cancer. MATERIAL AND METHODS Relevant publications were identified through Medline (www. ncbi.nlm.nih.gov), Embase (www.embase.com) and the US National Library of Medicine (www.clinicaltrials.org) databases using the following keywords, alone or in association, «prostate cancer; metastasis; oligo-metastasis». Articles were selected according to methods, language of publication and relevance. After careful selection 99 publications were eligible for our review. RESULTS Oligometastatic prostate cancer is a new entity including prostate cancer with a limited number of metastasis. This particular state becomes more frequent with the imaging progresses especially with the common use of new PET imaging with Choline or PSMA. There is no consensus about a strict definition of oligometastatic prostate cancer, number and sites of metastasis vary widely in the literature. Moreover, oligometastatic state can be observed de novo at the time of prostate cancer diagnosis as well as in case of recurrence after a primary treatment. There is actually an important lack of evidence-based medicine and no guidelines regarding treatment can be found. In de novo oligo-metatastatic prostate cancer, treatment of the primary tumor in association with androgen deprivation therapy seems to increase survival in selected patients but this needs to be confirmed by ongoing prospective clinical trials. In recurrent prostate cancer, metastasis directed therapy with or without androgen deprivation therapy is now routinely performed but its impact needs also to be analyzed. CONCLUSION In absence of consensus or guidelines, management of prostate cancer should be an individualized, patient-based management taking into account primary tumor stage and grade, number and types of metastasis and patient characteristics.
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Affiliation(s)
- F Kleinclauss
- Service d'urologie, andrologie et transplantation rénale, CHRU Besançon, Besançon, France; Université de Franche-Comté, Besançon, France; INSERM 1098, Besançon, France.
| | - A Thiery-Vuillemin
- Université de Franche-Comté, Besançon, France; INSERM 1098, Besançon, France; Service d'oncologie médicale, CHRU Besançon, Besançon, France
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11
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Stereotactic radiotherapy in metastatic breast cancer. Breast 2018; 41:57-66. [DOI: 10.1016/j.breast.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/09/2018] [Accepted: 06/21/2018] [Indexed: 12/19/2022] Open
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Thomas A, Khan SA, Chrischilles EA, Schroeder MC. Initial Surgery and Survival in Stage IV Breast Cancer in the United States, 1988-2011. JAMA Surg 2017; 151:424-31. [PMID: 26629881 DOI: 10.1001/jamasurg.2015.4539] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Management of the primary tumor site in patients with metastatic breast cancer remains controversial. OBJECTIVE To evaluate the patterns of receipt of initial breast surgery for female patients with stage IV breast cancer in the United States, with particular attention to women who survived at least 10 years. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) program. Female patients diagnosed as having stage IV breast cancer between 1988 and 2011 and who did not receive radiation therapy as part of the first course of treatment were included (N = 21 372). Kaplan-Meier estimates of median survival and descriptive statistics were used to compare patient and tumor characteristics by receipt of breast surgery at diagnosis. A Royston-Parmar survival model and logistic regression analysis assessed demographic and clinical factors associated with survival and prolonged survival (of at least 10 years). MAIN OUTCOMES AND MEASURES Differences in survival, particularly survival of at least 10 years, by receipt of initial surgery to the primary tumor. RESULTS Among the 21 372 patients, the median survival increased from 20 months (1988-1991) to 26 months (2007-2011). During this time, the rate of surgery declined (odds ratio [OR], 0.16; 95% CI, 0.12-0.21). Even so, receipt of surgery was associated with improved survival in multivariate analysis, which controlled for patient and clinical characteristics, along with time period (hazard ratio, 0.60; 95% CI, 0.57-0.63). For women diagnosed as having cancer before 2002 (n = 7504), survival of at least 10 years was seen in 9.6% (n = 353) and 2.9% (n = 107) of those who did and did not receive surgery, respectively (OR, 3.61; 95% CI, 2.89-4.50). In multivariate analysis, survival of at least 10 years was associated with receipt of surgery (odds ratio, 2.80; 95% CI, 2.08-3.77), hormone receptor-positive disease (OR, 1.76; 95% CI, 1.25-2.48), older age (OR, 0.41; 95% CI, 0.32-0.54), larger tumor size (OR, 0.37; 95% CI, 0.27-0.51), marital status of being separated at the time of diagnosis (OR, 0.67; 95% CI, 0.51-0.88), and more recent year of diagnosis (OR, 1.43; 95% CI, 1.02-1.99). CONCLUSIONS AND RELEVANCE Survival in stage IV breast cancer has improved and is increasingly of prolonged duration, particularly for some women undergoing initial breast surgery. As systemic therapy advances provide better control of distant disease in stage IV breast cancer, and as women present with lower distant disease burdens, these findings on initial surgery to the primary tumor may be of importance.
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Affiliation(s)
- Alexandra Thomas
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Seema A Khan
- Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Mary C Schroeder
- Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City
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13
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Bansal P, Rusthoven C, Boumber Y, Gan GN. The role of local ablative therapy in oligometastatic non-small-cell lung cancer: hype or hope. Future Oncol 2016; 12:2713-2727. [PMID: 27467543 DOI: 10.2217/fon-2016-0219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In recent years, the emergence of the oligometastatic state has called into question whether patients found to have a limited or low metastatic tumor burden may benefit from locally ablative therapy (LAT). In the past two decades, stereotactic body radiation therapy has been increasingly used to safely deliver LAT and provide high local control in nonoperable non-small-cell lung cancer patients. Mostly retrospective analyses suggest that using LAT for oligometastatic disease in non-small-cell lung cancer offers excellent local control and may provide an improvement in progression-free survival. Any meaningful improvement in cancer-specific survival remains debatable. We examine the role of integrating LAT in this patient population and the rationale behind its use in combination with targeted therapy and immunotherapy.
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Affiliation(s)
- Pranshu Bansal
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Hematology/Oncology Fellowship Program, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | - Yanis Boumber
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Cancer Genetics, Epigenetics & Genomics Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA
| | - Gregory N Gan
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Section of Radiation Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Cancer Therapeutics: Technology, Discovery & Targeted Delivery Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA
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14
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Scheer M, Dantonello T, Hallmen E, Vokuhl C, Leuschner I, Sparber-Sauer M, Kazanowska B, Niggli F, Ladenstein R, Bielack SS, Klingebiel T, Koscielniak E. Primary Metastatic Synovial Sarcoma: Experience of the CWS Study Group. Pediatr Blood Cancer 2016; 63:1198-206. [PMID: 27003095 DOI: 10.1002/pbc.25973] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/07/2016] [Accepted: 02/20/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prognostic factors for localized synovial sarcoma are well defined. However, few data exist regarding patients with metastases at diagnosis. Poor outcome is described but the optimal therapeutic regimen remains unclear. Our aim was to assess the outcome, identify prognostic factors, and analyze treatment strategies. METHODS Patients <21 years with synovial sarcoma and primary distant metastases treated in the consecutive prospective European Cooperative Weichteilsarkom Studiengruppe trials 1980-2010 were analyzed. RESULTS Twenty-nine of 296 patients had primary metastases. Twenty-seven could be included. Median age was 16.7 years. Primaries were mainly located in the limbs (78%) and 74% were ≥10 cm. Metastases involved the lungs in all patients. Two patients presented with synchronous bone metastases. Sixty-three percent of patients achieved a first remission, whereas only 26% maintained it. Relapses were metastatic with pulmonary metastases in nearly all patients. Five-year event-free survival and overall survival (OS) rates were 26% and 30%, respectively. Prognosis was best for patients with oligometastatic lung metastases (5-year OS probability 85%). Prognosis was worse for patients with multiple bilateral lung metastases (5-year OS 13%) and even poorer for those with concurrent bone metastases. Treatment elements associated with superior survival were adequate local therapy of the primary tumor and, if feasible, for metastases, chemotherapy with an ifosfamide/doxorubicin-based regimen. The use of whole lung irradiation was not correlated with better outcomes. CONCLUSIONS The overall prognosis of primary metastatic synovial sarcoma is poor. However, individuals with oligometastatic lung metastases had very good chance for long-term survival when treated with adequate multimodal therapy.
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Affiliation(s)
- Monika Scheer
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - Erika Hallmen
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Christian Vokuhl
- Department of Pediatric Pathology, Kiel Pediatric Tumor Registry, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Ivo Leuschner
- Department of Pediatric Pathology, Kiel Pediatric Tumor Registry, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | | | - Bernarda Kazanowska
- Department of Pediatric Hematology/Oncology and BMT, University of Wroclaw, Wroclaw, Poland
| | - Felix Niggli
- Department of Pediatric Oncology, University of Zurich, Zurich, Switzerland
| | - Ruth Ladenstein
- St. Anna Kinderspital and St. Anna Kinderkrebsforschung e.V, Vienna, Austria
| | - Stefan S Bielack
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany.,Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Münster, Germany
| | - Thomas Klingebiel
- Hospital for Children and Adolescents, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Ewa Koscielniak
- Pediatrics 5, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany.,Department of Pediatric Oncology, University of Tuebingen, Tuebingen, Germany
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15
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Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget 2015; 6:8491-524. [PMID: 25940699 PMCID: PMC4496163 DOI: 10.18632/oncotarget.3455] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 12/15/2022] Open
Abstract
Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.
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Affiliation(s)
- Diane K. Reyes
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Kenneth J. Pienta
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
- Departments of Pharmacology and Molecular Sciences, and Chemical and Biomolecular Engineering, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
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16
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Di Gioia D, Stieber P, Schmidt GP, Nagel D, Heinemann V, Baur-Melnyk A. Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase. Br J Cancer 2015; 112:809-18. [PMID: 25647014 PMCID: PMC4453962 DOI: 10.1038/bjc.2015.8] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/08/2014] [Accepted: 12/21/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Follow-up care in breast cancer is still an issue of debate. Diagnostic methods are more sensitive, and more effective therapeutic options are now available. The risk of recurrence is not only influenced by tumour stage but also by the different molecular subtypes. This study was performed to evaluate the use of whole-body imaging combined with tumour marker monitoring for the early detection of asymptomatic metastatic breast cancer (MBC). METHODS This analysis was performed as part of a follow-up study evaluating 813 patients with a median follow-up of 63 months. After primary therapy, all patients underwent tumour marker monitoring for CEA, CA 15-3 and CA 125 at 6-week intervals within an intensified diagnostic aftercare algorithm. A reproducible previously defined increase was considered as a strong indicator of MBC. From 2007 to 2010, 44 patients with tumour marker increase underwent whole-body magnetic resonance imaging and/or an FDG-PET/CT scan. Histological clarification and/or imaging follow-up were done. RESULTS Metastases were detected in 65.9% (29/44) of patients, 13.6% (6/44) had secondary malignancies besides breast cancer and 20.5% (9/44) had no detectable malignancy. Limited disease was found in 24.1% (7/29) of patients. Median progression-free survival of MBC was 9.2 months and median overall survival was 41.1 months. The 3- and 5-year survival rates were 64.2% and 40.0%, respectively. CONCLUSIONS A reproducible tumour marker increase followed by whole-body imaging is highly effective for early detection. By consequence, patients might benefit from earlier detection and improved therapeutic options with a prolonged survival.
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Affiliation(s)
- D Di Gioia
- Department of Internal Medicine III, University Hospital Munich-Grosshadern, 81377 Munich, Germany
| | - P Stieber
- Institute of Clinical Chemistry, University Hospital Munich-Grosshadern, 81377 Munich, Germany
| | - G P Schmidt
- Institute of Clinical Radiology, University Hospital Munich-Grosshadern, 81377 Munich, Germany
| | - D Nagel
- Institute of Clinical Chemistry, University Hospital Munich-Grosshadern, 81377 Munich, Germany
| | - V Heinemann
- Department of Internal Medicine III, University Hospital Munich-Grosshadern, 81377 Munich, Germany
| | - A Baur-Melnyk
- Institute of Clinical Radiology, University Hospital Munich-Grosshadern, 81377 Munich, Germany
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17
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Newton PK, Mason J, Hurt B, Bethel K, Bazhenova L, Nieva J, Kuhn P. Entropy, complexity, and Markov diagrams for random walk cancer models. Sci Rep 2014; 4:7558. [PMID: 25523357 PMCID: PMC4894412 DOI: 10.1038/srep07558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 11/20/2014] [Indexed: 02/07/2023] Open
Abstract
The notion of entropy is used to compare the complexity associated with 12 common cancers based on metastatic tumor distribution autopsy data. We characterize power-law distributions, entropy, and Kullback-Liebler divergence associated with each primary cancer as compared with data for all cancer types aggregated. We then correlate entropy values with other measures of complexity associated with Markov chain dynamical systems models of progression. The Markov transition matrix associated with each cancer is associated with a directed graph model where nodes are anatomical locations where a metastatic tumor could develop, and edge weightings are transition probabilities of progression from site to site. The steady-state distribution corresponds to the autopsy data distribution. Entropy correlates well with the overall complexity of the reduced directed graph structure for each cancer and with a measure of systemic interconnectedness of the graph, called graph conductance. The models suggest that grouping cancers according to their entropy values, with skin, breast, kidney, and lung cancers being prototypical high entropy cancers, stomach, uterine, pancreatic and ovarian being mid-level entropy cancers, and colorectal, cervical, bladder, and prostate cancers being prototypical low entropy cancers, provides a potentially useful framework for viewing metastatic cancer in terms of predictability, complexity, and metastatic potential.
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Affiliation(s)
- Paul K Newton
- Viterbi School of Engineering, Department of Mathematics, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089-1191, USA
| | - Jeremy Mason
- Viterbi School of Engineering, Department of Mathematics, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089-1191, USA
| | - Brian Hurt
- Viterbi School of Engineering, Department of Mathematics, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089-1191, USA
| | - Kelly Bethel
- Scripps Clinic Medical Group, 10666 N. Torrey Pines Rd. MC 211C, La Jolla CA 92037
| | - Lyudmila Bazhenova
- UCSD Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA, 92093
| | - Jorge Nieva
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue Suite 3440, Los Angeles, CA 90033
| | - Peter Kuhn
- Department of Biological Sciences, University of Southern California, 3430 S. Vermont Ave, Suite 105, Los Angeles CA 90089-3301
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18
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Quinn EM, Kealy R, O'Meara S, Whelan M, Ennis R, Malone C, McLaughlin R, Kerin MJ, Sweeney KJ. Is there a role for locoregional surgery in stage IV breast cancer? Breast 2014; 24:32-7. [PMID: 25466502 DOI: 10.1016/j.breast.2014.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/23/2014] [Accepted: 10/25/2014] [Indexed: 11/19/2022] Open
Abstract
Current guidelines do not recommend locoregional surgery for Stage IV breast cancer at presentation despite some studies suggesting a survival benefit. We aimed to assess outcomes in patients with Stage IV breast cancer who underwent surgery. In a cohort study of all Stage IV breast cancers diagnosed at our tertiary-referral specialist centre between 2006 and 2012, we assessed patient survival in the context of demographics, histopathology, metastatic burden, and type of surgery performed. One hundred and nine patients were included; 52 underwent surgery. Patients in the surgery group had longer 5-year-survival (p = 0.003). Survival was also significantly longer in those with just one site of metastatic disease (p < 0.001). Patients with axillary cytology positive for regional metastases were less likely to proceed to surgery. Locoregional surgery does confer a survival advantage in Stage IV breast cancer. Assessment of preoperative axillary cytology may preclude some patients from proceeding to potentially beneficial locoregional surgery.
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Affiliation(s)
- Edel M Quinn
- Breastcheck Western Unit, Newcastle Road, Galway, Ireland.
| | - Rebecca Kealy
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Siobhan O'Meara
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Maria Whelan
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Rachel Ennis
- Department of Radiology, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Carmel Malone
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Ray McLaughlin
- Symptomatic Breast Unit, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Michael J Kerin
- Division of Surgery, National University of Ireland Galway, University Road, Galway, Ireland
| | - Karl J Sweeney
- Breastcheck Western Unit, Newcastle Road, Galway, Ireland
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19
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Eren OO, Ordu C, Selcuk NA, Akosman C, Ozturk MA, Özkan F, Gokce Ö, Oyan B. Bilateral synchronous adrenal metastasis of invasive ductal carcinoma treated with multimodality therapy including adrenalectomy and oophorectomy. J Oncol Pharm Pract 2014; 22:157-60. [PMID: 25227232 DOI: 10.1177/1078155214551314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 38-year-old woman presented with a mass in the left breast. Biopsy of the lesion revealed invasive ductal carcinoma. Bilateral adrenal metastasis was detected in whole body positron emission tomography scanning. Needle biopsy of the left adrenal lesion proved infiltration of malignant cells from breast carcinoma. After eight cycles of neoadjuvant (preoperative) chemotherapy, mastectomy, bilateral adrenalectomy, and bilateral oopherectomy were performed. No further hormonal treatment was recommended due to the resection of both adrenal glands and ovaries. The patient is still followed without any sign of progression. To our knowledge, this is the first case representing multimodality approach to breast cancer with bilateral synchronous adrenal metastasis. Patients with oligometastatic disease may benefit from aggressive treatment including local therapies.
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Affiliation(s)
- Orhan Onder Eren
- Department of Medical Oncology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Faculty of Medicine, Bilim University, Istanbul, Turkey
| | - Nalan A Selcuk
- Department of Nuclear Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Cengiz Akosman
- Department of Medical Oncology, Medical Park Hospital, Ordu, Turkey
| | - Mehmet Akif Ozturk
- Department of Internal Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Ferda Özkan
- Department of Pathology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Özcan Gokce
- Department of General Surgery, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Basak Oyan
- Department of Medical Oncology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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20
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Falk AT, Fenoglietto P, Azria D, Bourgier C. [New external radiotherapy technologies for breast cancer]. Cancer Radiother 2014; 18:480-5. [PMID: 25182528 DOI: 10.1016/j.canrad.2014.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
The purpose of new radiotherapy techniques is to better deliver dose conformation in the tumour volume while diminishing organs at risk exposition. Their development is soaring in the breast cancer field in the adjuvant setting with intensity-modulated radiation therapy but also in cerebral and extracerebral oligometastastic presentation. Their usage is still being debated for breast cancer care. The objective of this narrative review is to list and discuss clinical data at our disposal for these news technologies.
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Affiliation(s)
- A T Falk
- Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France; Université de Nice Sophia-Antipolis, BP 2135, 06103 Nice cedex 2, France
| | - P Fenoglietto
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France
| | - D Azria
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, institut de recherche en cancérologie de Montpellier, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Université de Montpellier 1, CS 19044, 34967 Montpellier cedex 2, France
| | - C Bourgier
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, institut de recherche en cancérologie de Montpellier, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Université de Montpellier 1, CS 19044, 34967 Montpellier cedex 2, France.
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21
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Bourgier C, Azria D, Fenoglietto P, Riou O, Almaghrabi MY, Supiot S, Mornex F, Giraud P. [Stereotactic body radiation therapy and oligometastases]. Cancer Radiother 2014; 18:337-41. [PMID: 24792996 DOI: 10.1016/j.canrad.2014.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/13/2014] [Indexed: 01/14/2023]
Abstract
In stage IV cancers, locoregional management of primitive tumours as surgery and/or radiotherapy improved both progression-free survival and overall survival. Among metastatic cancer patients, some of them are considered as oligometastatic stage as they present few metastatic sites associated with low tumor aggressiveness. For those patients, metastatic local control, and therefore prolonged time to progression should be reached through local treatments as surgery and/or radiofrequency ablation and/or stereotactic radiotherapy. Here we propose a review of oligometastatic stage and results from extracranial stereotactic radiotherapy in terms of efficacy and tolerance.
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Affiliation(s)
- C Bourgier
- Service de radiothérapie, institut régional du cancer de Montpellier, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France; U896, université Montpellier 1, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France.
| | - D Azria
- Service de radiothérapie, institut régional du cancer de Montpellier, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France; U896, université Montpellier 1, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France
| | - P Fenoglietto
- Service de radiothérapie, institut régional du cancer de Montpellier, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France
| | - O Riou
- Service de radiothérapie, institut régional du cancer de Montpellier, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, 208, rue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 05, France
| | - M-Y Almaghrabi
- Institut de cancérologie de l'ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Inserm UMR, centre de recherche en cancérologie Nantes-Angers, 44007 Nantes cedex 1, France
| | - S Supiot
- Institut de cancérologie de l'ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Inserm UMR, centre de recherche en cancérologie Nantes-Angers, 44007 Nantes cedex 1, France
| | - F Mornex
- Département de radiothérapie-oncologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, Lyon, France
| | - P Giraud
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblance, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-médecine, 75006 Paris, France
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22
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Miyazaki H, Takabe K, Yeudall WA. Chemokines, chemokine receptors and the gastrointestinal system. World J Gastroenterol 2013; 19:2847-2863. [PMID: 23704819 PMCID: PMC3660811 DOI: 10.3748/wjg.v19.i19.2847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/13/2012] [Accepted: 04/27/2013] [Indexed: 02/06/2023] Open
Abstract
The biological properties of tumor cells are known to be regulated by a multitude of cytokines and growth factors, which include epidermal growth factor receptor agonists and members of the transforming growth factor β family. Furthermore, the recent explosion of research in the field of chemokine function as mediators of tumor progression has led to the possibility that these small, immunomodulatory proteins also play key roles in carcinogenesis and may, therefore, be potential targets for novel therapeutic approaches. In this review, we will summarize recently reported findings in chemokine biology with a focus on the gastrointestinal tract.
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23
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Corbin KS, Hellman S, Weichselbaum RR. Extracranial oligometastases: a subset of metastases curable with stereotactic radiotherapy. J Clin Oncol 2013; 31:1384-90. [PMID: 23460715 DOI: 10.1200/jco.2012.45.9651] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Stereotactic body radiotherapy for metachronous multisite oligo-recurrence: a long-surviving case with sequential oligo-recurrence in four different organs treated using locally radical radiotherapy and a review of the literature. Pulm Med 2012; 2012:713073. [PMID: 23150822 PMCID: PMC3486341 DOI: 10.1155/2012/713073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/13/2012] [Indexed: 12/12/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) for oligometastases represents a recent trend in radiation oncology. While abundant data are available regarding the use of SBRT for the treatment of lung or liver oligometastases from various retrospective series and prospective trials, relatively little information has been accumulated for the treatment of oligometastases at sites other than the lungs and liver, particularly for sequential oligometastases in multiple organs. Oligometastases with primary lesions controlled is called “oligo-recurrence.” We describe herein the case of a lung cancer patient who developed repeated oligo-recurrence at multiple sites that were each controlled by radical radiotherapy and achieved long-term survival and discuss the merits of locally aggressive radiotherapy for this type of disease condition with reviewing the literature. Although further investigation should be undertaken to clarify the benefits, objectives, and methods of SBRT for the treatment of oligometastases, we believe utilization of SBRT may be worthwhile for patients with remote metastases who hope for treatment to acquire better local control and possible longer survival.
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Nguyen DHA, Truong PT, Walter CV, Hayashi E, Christie JL, Alexander C. Limited M1 disease: a significant prognostic factor for stage IV breast cancer. Ann Surg Oncol 2012; 19:3028-34. [PMID: 22476751 DOI: 10.1245/s10434-012-2333-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE The prognosis of patients with breast cancer presenting with distant metastasis can vary depending on disease extent. This study evaluates a definition of limited M1 disease in association with survival in a cohort of women presenting with metastatic breast cancer. METHODS The study cohort comprised 692 women referred to the BC Cancer Agency between 1996 and 2005 with M1 breast cancer at presentation. Limited M1 disease was defined as <5 metastatic lesions confined to one anatomic subsite. Extensive M1 disease was defined as ≥ 5 lesions or disease in more than one subsite. Clinicopathologic and treatment characteristics and overall survival (OS) were compared between subjects with limited (n = 233) versus extensive (n = 459) M1 disease. Multivariable analysis was performed by Cox regression modeling. RESULTS Median follow-up time was 1.9 years. Five-year Kaplan-Meier OS was significantly higher in patients with limited compared to extensive M1 disease (29.7 vs. 13.1 %, p < 0.001). In the multivariable Cox regression analysis, limited M1 disease was significantly associated with OS (hazard ratio 0.51, 95 % confidence interval 0.40-0.66, p < 0.001). The only patient subsets with limited M1 disease with poor 5-year OS <15 % were patients with Eastern Cooperative Oncology Group performance status of ≥ 2 or estrogen receptor-negative status. CONCLUSIONS Limited M1 disease, defined as <5 metastatic lesions confined to one anatomic subsite, is a relevant favorable prognostic factor in patients with stage IV breast cancer. This definition may be used in conjunction with other clinicopathologic factors to select patients for more aggressive systemic and locoregional treatments.
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Affiliation(s)
- David H A Nguyen
- Radiation Therapy Program, Vancouver Island Centre, British Columbia Cancer Agency, Victoria, Canada.
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Takeda A, Kunieda E, Ohashi T, Aoki Y, Koike N, Takeda T. Stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer and other primary cancers in comparison with primary lung cancer. Radiother Oncol 2012; 101:255-9. [PMID: 21641064 DOI: 10.1016/j.radonc.2011.05.033] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/08/2011] [Accepted: 05/12/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze local control of oligometastatic lung tumors (OLTs) compared with that of primary lung cancer after stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS Retrospective record review of patients with OLTs who received SBRT with 50Gy in 5 fractions. Local control rates (LCRs), toxicities, and factors of prognostic significance were assessed. RESULTS Twenty-one colorectal OLTs, 23 OLTs from other origins, and 188 primary lung cancers were included. Multivariate analysis revealed only tumor origin was prognostically significant (p<0.05). The 1-year/2-year LCRs in colorectal OLTs and OLTs from other origins were 80%/72% and 94%/94%, respectively. The LCR in colorectal OLTs was significantly worse than that in OLTs from the other origins and primary lung cancers with pathological and clinical diagnosis (p<0.05, p<0.0001 and p<0.005). Among 44 OLT patients, Grades 2 and 3 radiation pneumonitis were identified in 2 and 1 patients, respectively. No other toxicities of more than Grade 3 occurred. CONCLUSION SBRT for OLTs is tolerable. The LCR for OLTs from origins other than colorectal cancer is excellent. However, LCR for colorectal OLTs is worse than that from other origins. Therefore dose escalation should be considered to achieve good local control for colorectal OLTs.
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Dellas K. Does Radiotherapy Have Curative Potential in Metastatic Patients? The Concept of Local Therapy in Oligometastatic Breast Cancer. Breast Care (Basel) 2011; 6:363-368. [PMID: 22619646 PMCID: PMC3357150 DOI: 10.1159/000333115] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 1995, Hellmann and Weichselbaum defined for the first time the term oligometastases which is used to describe limited metastasis with a maximum of 3-4 clinically detectable metastases. It is assumed that these patients have a better prognosis and that local treatment of the metastases plays a significant part in the further development of the disease. Therefore, these patients could benefit from a curative local therapy of the manifested metastases. Local therapy measures include mainly radiotherapeutic methods alongside invasive ablative processes, such as surgical resection and radiofrequency ablation. Patients subjected to radiation therapy benefit especially from the usage of modern precision technology as it reduces the radiation exposure to the normal tissue, and because short radiation sessions with escalating doses are possible (e.g. radiation surgery, image-assisted radiation therapy, stereotactic radiation). Initial clinical studies show very good local tumor control rates which are on a par with resection and ablative methods, but with very few side effects and risks. This article summarizes the integration of the concept of oligometastases in the radiotherapy of limited metastatic breast cancer.
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Affiliation(s)
- Kathrin Dellas
- North European Radiooncological Center Kiel and University of Luebeck, Department of Radiotherapy, Germany
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Noguchi M, Nakano Y, Noguchi M, Ohno Y, Kosaka T. Local therapy and survival in breast cancer with distant metastases. J Surg Oncol 2011; 105:104-10. [DOI: 10.1002/jso.22056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 07/18/2011] [Indexed: 11/08/2022]
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Isolated sternal involvement in breast cancer: is it truly stage IV disease? Clin Breast Cancer 2011; 11:191-4. [PMID: 21665140 DOI: 10.1016/j.clbc.2011.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/06/2011] [Accepted: 02/07/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE There is no consensus regarding treatment for patients with breast cancer and isolated sternal involvement. Though classified as AJCC stage IV, this group of patients may have prolonged distant disease free survival. PATIENTS AND METHODS Retrospective case series of 8 patients with isolated sternal recurrence. Information regarding age, menopausal status, hormonal receptor status, HER2 status, initial treatment, time to sternal recurrence, treatment of sternal involvement, and outcome was obtained. RESULTS Median follow-up, 6 years. Seven of 8 diagnosed with metachronous sternal recurrence at a median of 3 years from initial breast cancer diagnosis, 1 with sternal involvement at initial diagnosis. Seven of 8 are alive, with one death from metastatic breast cancer 10 years after sternal recurrence. Six of 8 are without evidence of distant spread, 2 in continuous complete remission (CR) at 7 and 14 years from sternal recurrence. CONCLUSION While a small cohort, the excellent survival of the group identifies this as a distinct subset of metastatic disease, requiring special treatment considerations. Isolated sternal involvement could represent direct local-regional extension rather than systemic spread.
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Chockalingam P, Astrow A, Klein P, Huang Y, Reichman •, Citron M. Isolated Sternal Involvement in Breast Cancer: Is it Truly Stage IV Disease? Clin Breast Cancer 2011. [DOI: 10.1016/j.clbc.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Current diagnostic modalities and clinical pitfalls in malignant secondary breast tumours. Arch Gynecol Obstet 2011; 284:687-94. [DOI: 10.1007/s00404-011-1904-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
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[Multimodality treatment concepts for metastatic breast cancer]. Internist (Berl) 2010; 51:1358-65. [PMID: 21107788 DOI: 10.1007/s00108-010-2676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While metastatic breast cancer is a systemic disease in most patients, there is a smaller subset of patients who suffer from oligometastatic disease defined by single or few resectable metastases. After verification of disease stabilization by systemic therapy, locoregional treatment such as surgery or radiation can be applied. While large prospective trials are missing to support the beneficial effect of this strategy, retrospective analyses are highly suggestive offering rapid disease control and even long-term survival in selected patients.
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Predictors of local control after single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases. Int J Radiat Oncol Biol Phys 2010; 79:1151-7. [PMID: 20510537 DOI: 10.1016/j.ijrobp.2009.12.038] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/04/2009] [Accepted: 12/04/2009] [Indexed: 12/13/2022]
Abstract
PURPOSE To report tumor local control after treatment with single-dose image-guided intensity-modulated radiotherapy (SD-IGRT) to extracranial metastatic sites. METHODS AND MATERIALS A total of 126 metastases in 103 patients were treated with SD-IGRT to prescription doses of 18-24 Gy (median, 24 Gy) between 2004 and 2007. RESULTS The overall actuarial local relapse-free survival (LRFS) rate was 64% at a median follow-up of 18 months (range, 2-45 months). The median time to failure was 9.6 months (range, 1-23 months). On univariate analysis, LRFS was significantly correlated with prescription dose (p = 0.029). Stratification by dose into high (23 to 24 Gy), intermediate (21 to 22 Gy), and low (18 to 20 Gy) dose levels revealed highly significant differences in LRFS between high (82%) and low doses (25%) (p < 0.0001). Overall, histology had no significant effect on LRFS (p = 0.16). Renal cell histology displayed a profound dose-response effect, with 80% LRFS at the high dose level (23 to 24 Gy) vs. 37% with low doses (≤22 Gy) (p = 0.04). However, for patients who received the high dose level, histology was not a statistically significant predictor of LRFS (p = 0.90). Target organ (bone vs. lymph node vs. soft tissues) (p = 0.5) and planning target volume size (p = 0.55) were not found to be associated with long-term LRFS probability. Multivariate Cox regression analysis confirmed prescription dose to be a significant predictor of LRFS (p = 0.003). CONCLUSION High-dose SD-IGRT is a noninvasive procedure resulting in high probability of local tumor control. Single-dose IGRT may be effectively used to locally control metastatic deposits regardless of histology and target organ, provided sufficiently high doses (> 22 Gy) of radiation are delivered.
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Patterns of recurrence after curative-intent radiation for oligometastases confined to one organ. Am J Clin Oncol 2010; 33:157-63. [PMID: 19770627 DOI: 10.1097/coc.0b013e3181979238] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We sought to characterize and describe the patterns of distant recurrence in patients with macroscopic oligometastases, limited in number (<or=5) and confined to one organ, treated with curative-intent stereotactic body radiotherapy (SBRT). METHODS Seventy-seven patients enrolled on prospective studies of SBRT for oligometastases are included in the present analysis. All available radiography and records were retrospectively reviewed to determine the timing and location of recurrences. RESULTS New metastases occurred in 73% of patients. Among these patients, new metastases developed most frequently in the same organ (occurring in 82% of first new metastases after SBRT and 89% of cumulative new metastases). Metastases to other organs were common as well (occurring cumulatively in 79% of patients). In patients with liver oligometastases, common sites of further progression included the liver, other abdominal organs, and lungs. In patients with lung oligometastases, common sites of further progression included the lungs, thoracic lymph nodes, bones, liver, and brain. CONCLUSIONS Patients receiving SBRT for oligometastases confined to one organ are apt to develop new metastases, most frequently occurring in the initially involved organ, but also commonly in other organs. A subset of patients remains disease free after extended follow-up.
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Pagani O, Senkus E, Wood W, Colleoni M, Cufer T, Kyriakides S, Costa A, Winer EP, Cardoso F. International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured? J Natl Cancer Inst 2010; 102:456-63. [PMID: 20220104 PMCID: PMC3298957 DOI: 10.1093/jnci/djq029] [Citation(s) in RCA: 270] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/20/2010] [Accepted: 01/21/2010] [Indexed: 01/05/2023] Open
Abstract
A distinctive subset of metastatic breast cancer (MBC) is oligometastatic disease, which is characterized by single or few detectable metastatic lesions. The existing treatment guidelines for patients with localized MBC include surgery, radiotherapy, and regional chemotherapy. The European School of Oncology-Metastatic Breast Cancer Task Force addressed the management of these patients in its first consensus recommendations published in 2007. The Task Force endorsed the possibility of a more aggressive and multidisciplinary approach for patients with oligometastatic disease, stressing also the need for clinical trials in this patient population. At the sixth European Breast Cancer Conference, held in Berlin in March 2008, the second public session on MBC guidelines addressed the controversial issue of whether MBC can be cured. In this commentary, we summarize the discussion and related recommendations regarding the available therapeutic options that are possibly associated with cure in these patients. In particular, data on local (surgery and radiotherapy) and chemotherapy options are discussed. Large retrospective series show an association between surgical removal of the primary tumor or of lung metastases and improved long-term outcome in patients with oligometastatic disease. In the absence of data from prospective randomized studies, removal of the primary tumor or isolated metastatic lesions may be an attractive therapeutic strategy in this subset of patients, offering rapid disease control and potential for survival benefit. Some improvement in outcome may also be achieved with optimization of systemic therapies, possibly in combination with optimal local treatment.
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Affiliation(s)
- Olivia Pagani
- Oncology Institute of Southern Switzerland, Ospedale Italiano, Viganello, Lugano, Switzerland
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Beriwal S. PET/CT in Radiation Therapy Planning for Breast Cancer. PET Clin 2009; 4:349-57. [PMID: 27157304 DOI: 10.1016/j.cpet.2009.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PET/computed tomography-based imaging is a valuable and useful test in the staging and restaging of breast cancer, especially in patients who have recurrent or locally advanced breast cancer. Its greatest clinical applications are in the detection and definition of the extent of recurrent or metastatic disease. However, the potential to improve radiation treatment planning by allowing for the tailoring of comprehensive radiation portals, particularly for locally advanced or recurrent breast cancer, makes it one of the most promising tools in the era of image-guided radiation therapy.
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Affiliation(s)
- Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, USA
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Oh Y, Taylor S, Bekele BN, Debnam JM, Allen PK, Suki D, Sawaya R, Komaki R, Stewart DJ, Karp DD. Number of metastatic sites is a strong predictor of survival in patients with nonsmall cell lung cancer with or without brain metastases. Cancer 2009; 115:2930-8. [DOI: 10.1002/cncr.24333] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Milano MT, Philip A, Okunieff P. Analysis of patients with oligometastases undergoing two or more curative-intent stereotactic radiotherapy courses. Int J Radiat Oncol Biol Phys 2008; 73:832-7. [PMID: 18760543 DOI: 10.1016/j.ijrobp.2008.04.073] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 04/23/2008] [Accepted: 04/30/2008] [Indexed: 12/01/2022]
Abstract
PURPOSE A subset of patients treated with curative-intent stereotactic radiotherapy (RT) for limited metastases (defined as five lesions or fewer) develop local failure and/or a small number of new lesions. We hypothesized that these patients would remain amenable to curative-intent treatment with additional RT courses. METHODS AND MATERIALS Of 121 prospective patients with five lesions or fewer treated with stereotactic RT, 32 underwent additional RT courses for local failure (n = 9) and/or new lesions (n = 29). Ten patients underwent three or more courses of RT. RESULTS The treated local failures developed a median of 20 months after RT completion. For the new oligometastases, the interval between the first and second RT course was 1-71 months (median, 8). Of the 32 patients undergoing multiple courses of curative-intent RT, the 2-year overall survival and progression-free survival rate was 65% and 54%, respectively. The corresponding 4-year rates were 33% and 28%. Compared with the 89 patients who underwent one RT course, these patients experienced a trend toward improved overall survival (median, 32 vs. 21 months, p = 0.13) and significantly greater progression-free survival (median, 28 vs. 9 months, p = 0.008). CONCLUSION The results of our study have shown that patients fare well with respect to survival and disease control with aggressive RT for limited metastases, even after local failure and/or the development of new metastases. Although patients amenable to multiple courses of curative-intent RT are arguably selected for more indolent disease, our hypothesis-generating analysis supports the notion of aggressively treating limited metastases, which, in some patients, might be curable and/or represent a chronic disease state.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Milano MT, Zhang H, Metcalfe SK, Muhs AG, Okunieff P. Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy. Breast Cancer Res Treat 2008; 115:601-8. [PMID: 18719992 DOI: 10.1007/s10549-008-0157-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/06/2008] [Indexed: 12/17/2022]
Abstract
PURPOSE Prospective pilot study to assess patient outcome after stereotactic body radiation therapy (SBRT) for limited metastases from breast cancer. METHODS Forty patients with < or =5 metastatic lesions received curative-intent SBRT, while 11 patients with >5 lesions, undergoing SBRT to < or =5 metastatic lesions, were treated with palliative-intent. RESULTS Among those treated with curative-intent, 4-year actuarial outcomes were: overall survival of 59%, progression-free survival of 38% and lesion local control of 89%. On univariate analyses, 1 metastatic lesion (versus 2-5), smaller tumor volume, bone-only disease, and stable or regressing lesions prior to SBRT were associated with more favorable outcome. Patients treated with palliative-intent SBRT were spared morbidity and mortality from progression of treated lesions, though all developed further metastatic progression shortly (median 4 months) after enrollment. CONCLUSIONS SBRT may yield prolonged survival and perhaps cure in select patients with limited metastases. Palliative-intent SBRT may be warranted for symptomatic or potentially symptomatic metastases.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box 647, Rochester, NY 14642, USA.
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Milano MT, Katz AW, Schell MC, Philip A, Okunieff P. Descriptive analysis of oligometastatic lesions treated with curative-intent stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72:1516-22. [PMID: 18495378 DOI: 10.1016/j.ijrobp.2008.03.044] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/22/2008] [Accepted: 03/11/2008] [Indexed: 12/13/2022]
Abstract
PURPOSE To characterize oligometastases in patients enrolled on two prospective pilot studies, treating oligometastases with hypofractionated stereotactic body radiotherapy and stereotactic radiosurgery to cranial lesions. METHODS AND MATERIALS We describe the characteristics and local control (LC) of 293 lesions in 121 patients with five or fewer metastases treated with stereotactic body radiation and/or cranial stereotactic radiosurgery. For each lesion, the primary cancer site, tumor histology, site of metastasis, gross tumor volume, and prescribed dose were ascertained. The prescribed dose is expressed by the biologically effective dose in 2-Gy fractions (BED2), calculated using the linear quadratic model, assuming an alpha/beta ratio of 10. RESULTS Lung lesions were significantly smaller than other lesions in our cohort, whereas liver lesions were significantly larger, possibly reflecting a detection and/or referral bias. The 2-year and 4-year tumor LC rates were 77% and 73% respectively. A larger gross tumor volume was significantly (p < 0.0001) correlated with worse lesion LC. Lesions originating from primary pancreatic, biliary or liver cancer exhibited significantly poorer LC, as did lesions from colorectal cancer. Lesions from breast cancer were better controlled. A higher BED2 did not correlate with improved tumor control. CONCLUSIONS Stereotactic body radiation to aggressively treat oligometastatic lesions results in good local tumor control. Bulkier lesions are more difficult to control and may benefit from dose escalation.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
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Milano MT, Katz AW, Muhs AG, Philip A, Buchholz DJ, Schell MC, Okunieff P. A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions. Cancer 2008; 112:650-8. [DOI: 10.1002/cncr.23209] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Recent studies have highlighted the possible involvement of chemokines and their receptors in breast cancer progression and metastasis. Chemokines and their receptors constitute a superfamily of signalling factors whose prognosis value in breast cancer progression remains unclear. We will examine here the expression pattern of chemokines and their receptors in mammary gland physiology and carcinogenesis. The nature of the cells producing chemokines or harboring chemokine receptors appears to be crucial in certain conditions for example, the infiltration of the primary tumor by leukocytes and angiogenesis. In addition, chemokines, their receptors and the interaction with glycosaminoglycan (GAGs) are key players in the homing of cancer cells to distant metastasis sites. Several lines of evidence, including in vitro and in vivo models, suggest that the mechanism of action of chemokines in cancer development involves the modulation of proliferation, apoptosis, invasion, leukocyte recruitment or angiogenesis. Furthermore, we will discuss the regulation of chemokine network in tumor neovascularity by decoy receptors. The reasons accounting for the deregulation of chemokines and chemokine receptors expression in breast cancer are certainly crucial for the comprehension of chemokine role in breast cancer and are in several cases linked to estrogen receptor status. The targeting of chemokines and chemokine receptors by antibodies, small molecule antagonists, viral chemokine binding proteins and heparins appears as promising tracks to develop therapeutic strategies. Thus there is significant interest in developing strategies to antagonize the chemokine function, and an opportunity to interfere with metastasis, the leading cause of death in most patients.
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Affiliation(s)
- Simi Ali
- School of Surgical and Reproductive Sciences, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4HH, UK.
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Mankoff D, Gralow J. 3–12 The Role of FDG-PET/CT in Suspected Recurrence of Breast Cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1043-321x(07)80306-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Patients with distant metastases from breast cancer have always been considered terminally ill and as such candidates for palliative treatment only. However, due to new therapeutic modalities in oncology, survival in these patients has improved. Furthermore, in 5% of patients, metastasis from breast cancer is limited to a single solid organ (oligometastatic state). Because of these two factors, surgery is now being performed as a component of multidisciplinary treatment for hepatic, lung and bone metastases from a primary breast tumor. In the present article, we review the different published series, focussing discussion on two issues: selecting candidates for liver, lung or bone resection, and identifying prognostic factors for recurrence and/or survival following surgical excision of metastases to these sites.
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Affiliation(s)
- Hipólito J Durán
- Departamento de Cirugía, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
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Conte PF, Bengala C, Guarneri V. Controversies of chemotherapy for the treatment of metastatic breast cancer. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70010-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Conte P, Bengala C. Current State of the Treatment in Metastatic Breast Cancer. J Breast Cancer 2006. [DOI: 10.4048/jbc.2006.9.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- PierFranco Conte
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital, University of Modena and Reggio Emilia Via del Pozzo, 71 41100 Modena, Italy
| | - Carmelo Bengala
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital, University of Modena and Reggio Emilia Via del Pozzo, 71 41100 Modena, Italy
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