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Le Scodan R, Ghannam Y, Kirova Y, Bourgier C, Richard Tallet A. Radiation therapy of the primary tumour and oligometastatic sites in patients with breast cancer with synchronous metastases: A literature review. Cancer Radiother 2024; 28:3-14. [PMID: 38065784 DOI: 10.1016/j.canrad.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 02/04/2024]
Abstract
De novo metastatic breast cancer represents 5 to 8% of all breast cancers (2500 new cases per year in France). Systemic treatment is the cornerstone of treatment, whereas radiation therapy usually has a palliative intent. Advances in systemic and local treatments (surgery and radiation therapy) have substantially improved overall survival. In the recent breast cancer statistics in the United States, the 5-year relative survival for patients diagnosed during 2012-2018 was 29% for stage IV (Breast Cancer Statistics). Thus, an increasing proportion of metastatic breast cancers present a prolonged complete response to systemic therapy, which raises the question of the impact of local treatment on patient survival. Radiation therapy has shown its value for early breast cancer, but its place in the local management of the primary tumour or oligometastatic sites for de novo metastatic breast cancer remains under debate. This article is a literature review assessing the role of radiation therapy directed to the primary tumour and oligometastatic sites of breast cancer in patients with synchronous metastases, in order to highlight clinicians in their therapeutic decision.
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Affiliation(s)
- R Le Scodan
- Institut de cancérologie et radiothérapie brétillien (ICRB), hôpitaux privés rennais, centre hospitalier privé Saint-Grégoire, Vivalto, Saint-Grégoire, France.
| | - Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, Angers, France
| | - Y Kirova
- Département de radiothérapie, institut Curie, Paris, France
| | - C Bourgier
- Université de Montpellier, Montpellier, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, institut régional du cancer Montpellier (ICM), Montpellier, France
| | - A Richard Tallet
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, Marseille, France; Centre de recherche en cancérologie de Marseille (CRCM), Inserm UMR 1068, Marseille, France
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Kim N, Kim H, Park W, Cho WK, Kim TG, Im YH, Ahn JS, Park YH, Kim JY. Impact of high dose radiotherapy for breast tumor in locoregionally uncontrolled stage IV breast cancer: a need for a risk-stratified approach. Radiat Oncol 2023; 18:168. [PMID: 37821947 PMCID: PMC10566115 DOI: 10.1186/s13014-023-02357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
AIM Patients with locoregionally uncontrolled breast tumors are frequently referred for breast palliative radiotherapy (PRT) to mitigate symptoms. We analyzed the outcomes following breast PRT to optimize PRT according to risk groups. METHODS We reviewed 133 patients who underwent breast PRT. A median total dose of 45 Gy was prescribed with an equivalent dose in 2 Gy fractions (EQD2, α/β = 3.5) of 53 Gy. The Cox proportional hazards model was used to analyze the prognostic factors of local control (LC). RESULTS Most (90.2%) had polymetastatic disease (> 5 lesions), and 48.9% had bone metastasis. With a median follow-up of 17.2 months, the 2-year LC and overall survival (OS) rates were 49.4%, and 48.3%, respectively. Multivariable analyses demonstrated progressive or mixed responses outside the breast and > 2 lines of previous therapy as adverse features for clinical outcomes. Group 1 (0 risk factors) showed favorable 2-year LC and OS of 63.9%, and 72.8%, respectively, whereas group 3 (2 risk factors) showed the worst outcomes of 0%, and 6.8%, respectively. Breast PRT with EQD2 ≥ 63 Gy showed a significant benefit in LC for group 1 and marginal benefit (p = 0.055) for group 2, but no improvement for group 3 (p = 0.300). CONCLUSION Breast PRT showed favorable LC outcomes in patients with stable disease outside the breast and treated with ≤ 2 lines of systemic treatment. Our findings warrant future clinical trials investigating the role of higher than palliative dose and early intervention of PRT in stage IV patients.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young-Hyuck Im
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hee Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kolberg HC, Hartkopf AD, Fehm TN, Welslau M, Müller V, Schütz F, Fasching PA, Janni W, Witzel I, Thomssen C, Beierlein M, Belleville E, Untch M, Thill M, Tesch H, Ditsch N, Lux MP, Aktas B, Banys-Paluchowski M, Kolberg-Liedtke C, Wöckel A, Harbeck N, Stickeler E, Bartsch R, Schneeweiss A, Ettl J, Krug D, Taran FA, Lüftner D, Würstlein R. Update Breast Cancer 2023 Part 3 - Expert Opinions of Early Stage Breast Cancer Therapies. Geburtshilfe Frauenheilkd 2023; 83:1117-1126. [PMID: 37706055 PMCID: PMC10497347 DOI: 10.1055/a-2143-8125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
The St. Gallen (SG) International Breast Cancer Conference is held every two years, previously in St. Gallen and now in Vienna. This year (2023) marks the eighteenth edition of this conference, which focuses on the treatment of patients with early-stage breast carcinoma. A panel discussion will be held at the end of this four-day event, during which a panel of experts will give their opinions on current controversial issues relating to the treatment of early-stage breast cancer patients. To this end, questions are generally formulated in such a way that clinically realistic cases are presented - often including poignant hypothetical modifications. This review reports on the outcome of these discussions and summarises the data associated with individual questions raised.
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Affiliation(s)
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Isabell Witzel
- Universitätsspital Zürich, Klinik für Gynäkologie, Zürich, Switzerland
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Milena Beierlein
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
| | | | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Gynecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Bahriye Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany
| | - Rupert Bartsch
- Medical University of Vienna, Department of Medicine I, Division of Oncology, Vienna, Austria
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Johannes Ettl
- Klinikum Kempten, Klinikverbund Allgäu, Klinik für Frauenheilkunde und Gynäkologie, Kempten, Germany
| | - David Krug
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Strahlentherapie, Kiel, Germany
| | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, University Hospital Freiburg, Freiburg, Germany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz, Buckow, Germany
- Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
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Miyashita M, Balogun OB, Olopade OI, Huo D. The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions. Sci Rep 2023; 13:2880. [PMID: 36804591 PMCID: PMC9938892 DOI: 10.1038/s41598-023-29888-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/11/2023] [Indexed: 02/20/2023] Open
Abstract
Prolonged survival of patients with stage IV breast cancer could change the role of radiotherapy for local control of breast primary, but its survival benefit remains unclear. Our aim is to investigate the survival benefit of radiotherapy in de novo stage IV breast cancer. Stage IV breast cancer patients who received breast surgery and have survived 12 months after diagnosis (landmark analysis) were included in the study from 2010 to 2015 of the National Cancer DataBase. Multivariable Cox models and a propensity score matching were used to control for confounding effects. Of 11,850 patients, 3629 (30.6%) underwent postoperative radiotherapy to breast or chest wall and 8221 (69.4%) did not. In multivariable analysis adjusting for multiple prognostic variables, postoperative radiotherapy was significantly associated with better survival (hazard ratio [HR] 0.74, 95% confidence interval [95%CI] 0.69-0.80; P < 0.001). Radiotherapy was associated with improved survival in patients with bone (P < 0.001) or lung metastasis (P = 0.014), but not in patients with liver (P = 0.549) or brain metastasis (P = 0.407). Radiotherapy was also associated with improved survival in patients with one (P < 0.001) or two metastatic sites (P = 0.028), but not in patients with three or more metastatic sites (P = 0.916). The survival impact of radiotherapy did not differ among subtypes. The results of survival analysis in the propensity score-matched sub-cohort were precisely consistent with those of multivariable analysis. These real-world data show that postoperative radiotherapy might improve overall survival for de novo Stage IV breast cancer with bone or lung metastasis, regardless of subtypes.
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Affiliation(s)
- Minoru Miyashita
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.,Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Onyinye B Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Olufunmilayo I Olopade
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Dezheng Huo
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA. .,Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
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Kwong A, Co M, Fukuma E. Prospective Clinical Trial on Expanding Indications for Cryosurgery for Early Breast Cancers. Clin Breast Cancer 2023; 23:363-368. [PMID: 36805386 DOI: 10.1016/j.clbc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/06/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This is a prospective single arm clinical trial on cryosurgery for early breast cancers, to evaluate the expanded criteria to tumors larger than 1.5 cm and non-luminal breast cancers. METHODS Inclusion criteria include Solitary T1 breast cancers of any immunohistotypes. Cryosurgery was performed using the IceCure ProSense Cryoablation System. Lumpectomy of the cryoablated tumor was then performed 8 weeks after cryosurgery. RESULTS Fifteen patients underwent cryosurgery followed by lumpectomy (BCS). Median age was 53 years old 5 (33.3%) patients had ductal carcinoma in situ (DCIS), while 10 (66.7%) patients had invasive ductal carcinoma (IDC), of which 5 (50%) patients had luminal type cancers of which 3 (60%) were luminal A and 2 (40%) luminal B, 3 (30%) patients had HER2 enriched invasive carcinoma and 2 (20%) patients had triple negative IDC. Median tumor size was 13mm (Range 8.6-18mm). Seven (46.7%) patients were found to have residual cancer in the post-cryosurgery lumpectomy specimen. All residual cancers were found at the periphery of the cryoablated breast tissue. All breast cancers were otherwise completely ablated centrally as confirmed by routine histopathology, immunochemistry and TUNEL assay for evaluation of cell viability. None of the tumor factors such as tumor biology, as well as surgical factors such as ablation time and iceball size, were associated with risk of residual cancer. None of the 15 patients developed post-operative complications. CONCLUSION Residual cancer occurs at the periphery of the cryoablation site, careful pre-operative planning and intra-operative monitoring is crucial to ensure complete cryoablation.
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Affiliation(s)
- Ava Kwong
- Department of Surgery, University of Hong Kong, HKSAR, China.
| | - Michael Co
- Department of Surgery, University of Hong Kong, HKSAR, China
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
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6
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Ghannam Y, Laville A, Kirova Y, Latorzeff I, Levy A, Zhou Y, Bourbonne V. Radiotherapy of the Primary Disease for Synchronous Metastatic Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235929. [PMID: 36497410 PMCID: PMC9736289 DOI: 10.3390/cancers14235929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
In the case of synchronous metastatic disease, the local treatment of primary tumors by radiotherapy has long been reserved for palliative indications. The emergence of the concept of oligometastatic and oligopersistent diseases, the advent of new systemic therapies enabling longer overall survival with an enhanced quality of life, a better understanding of the biologic history of metastatic spread, and technical advances in radiation therapy are revolutionizing the management of patients with de novo metastatic cancer. The prognosis of these patients has been markedly improved and many studies have investigated the survival benefits from the local treatment of various primary tumors in cases of advanced disease at the time of diagnosis or in the case of oligopersistence. This article provides an update on the place of irradiation of the primary tumor in cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Youssef Ghannam
- Radiation Oncology Department, Centre Paul Papin, Institut de Cancérologie de l’Ouest, 49055 Angers, France
- Correspondence: (Y.G.); (V.B.)
| | - Adrien Laville
- Radiation Oncology Department, CHU Amiens-Picardie, 80000 Amiens, France
| | - Youlia Kirova
- Radiation Oncology Department, Institut Curie Paris, CEDEX 05, 75248 Paris, France
| | - Igor Latorzeff
- Radiation Oncology Department, Bât Atrium Clinique Pasteur, 31300 Toulouse, France
| | - Antonin Levy
- Radiation Oncology Department, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Faculté de Médecine, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Yuedan Zhou
- Radiation Oncology Department, CHU Amiens-Picardie, 80000 Amiens, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- Correspondence: (Y.G.); (V.B.)
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Khan SA, Schuetz S, Hosseini O. Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol 2022; 29:5811-5820. [PMID: 35608802 DOI: 10.1245/s10434-022-11900-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Until 2001, the paradigm guiding the management of women with de novo metastatic breast cancer (dnMBC) stipulated that primary-site locoregional therapy (PSLT) did not alter the course of metastatic disease and was necessary only for palliation of symptoms. Since 2002, retrospective data have begun questioning this paradigm. However, selection biases driving an observed survival advantage associated with PSLT in dnMBC were quickly recognized and led to several randomized clinical trials (RCTs) addressing this question. METHODS AND RESULTS Four published RCTs have since tested the value of PSLT added to systemic therapy (ST) or not, with overall survival (OS) as the primary end point. The results of three published trials show no OS benefit for the addition of PSLT: Indian Tata Memorial, U.S./Canada E2108, and Austrian POSYTIVE (although POSYTIVE did not reach full accrual). The fourth RCT (Turkey, MF07-01) shows an OS benefit for PSLT at 5 years (42 % vs 24 % in the ST arm; hazard ratio [HR], 0.66; 95 % confidence interval [CI], 0.49-0.88). However, the 5-year survival in the PSLT arm of MF07-01 is similar to that in both arms of E2108, suggesting that the worse survival in the ST arm of MF07-01 is a result of biologically worse disease (from imbalanced randomization). Locoregional control was improved by PSLT in all trials, but without improvement in quality of life. CONCLUSIONS The current evidence fails to refute the 20th century paradigm guiding management of de novo metastatic breast cancer. Discussion continues regarding the survival value of PSLT for patients with bone-only disease or oligometastases, but unbiased evidence is lacking.
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Affiliation(s)
- Seema Ahsan Khan
- Department of Surgery, Feinberg School of Medicine of Northwestern University, 303 East Superior Street, Lurie 4-111, Chicago, IL, 60611, USA.
| | - Steven Schuetz
- Department of Surgery, Feinberg School of Medicine of Northwestern University, 303 East Superior Street, Lurie 4-111, Chicago, IL, 60611, USA
| | - Omid Hosseini
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
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Beduk Esen CS, Gultekin M, Yildiz F. Role of radiotherapy in oligometastatic breast cancer: Review of the literature. World J Clin Oncol 2022; 13:39-48. [PMID: 35116231 PMCID: PMC8790304 DOI: 10.5306/wjco.v13.i1.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/05/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Metastatic breast cancer has been historically considered as an incurable disease. Radiotherapy (RT) has been traditionally used for only palliation of the symptoms caused by metastatic lesions. However, in recent years the concept of oligometastatic disease has been introduced in Cancer Medicine as a clinical scenario with a limited number of metastases (≤ 5) and involved organs (≤ 2) with controlled primary tumor. The main hypothesis in oligometastatic disease is that locoregional treatment of primary tumor site and metastasis-directed therapies with surgery and/or RT may improve outcomes. Recent studies have shown that not all metastatic breast cancer patients have the same prognosis, and selected patients with good prognostic features as those younger than 55 years, hormone receptor-positive, limited bone or liver metastases, a low-grade tumor, good performance status, long disease-free interval (> 12 mo), and good response to systemic therapy may provide maximum benefit from definitive treatment procedures to all disease sites. While retrospective and prospective studies on locoregional treatment in oligometastatic breast cancer demonstrated conflicting results, there is an increasing trend in favor of locoregional treatment. Currently, available data also demonstrated the improvements in survival with metastasis-directed therapy in oligometastatic breast cancer. The current review will discuss the concept of oligometastases and provide up-to-date information about the role of RT in oligometastatic breast cancer.
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Affiliation(s)
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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Jianna S, Lingjun K, Nana F, Hong L, Chongxi R. Locoregional Therapy in De novo Metastatic Breast Cancer: A Retrospective Cohort Study. Technol Cancer Res Treat 2022; 21:15330338221115356. [PMID: 35899318 PMCID: PMC9340403 DOI: 10.1177/15330338221115356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Whether locoregional therapy (LRT) should be performed in
patients with de novo metastatic breast cancer (dnMBC) has been debated. Here we
report the survival outcomes of LRT in patients with dnMBC, focusing on the
association of surgical timings and surgical margins with survival in this
patient population. Methods: The retrospective study included
patients with dnMBC in our hospital, between March 1, 2007 and December 31,
2017. Overall survival (OS) was evaluated by means of a stratified log-rank test
and summarized with the use of Kaplan–Meier methods. Results: A
total of 153 patients were included, of whom 87 underwent LRT and 66 systemic
therapy alone (STA). LRT showed a significant OS benefit over STA (HR, 0.62; 95%
CI, 0.39 to 0.99; P = .043). The OS of LRT group and STA
group were 39 months (95% CI, 33.6 to 44.4 months) and 24.6 months (95% CI, 20.6
to 28.6 months), respectively. The benefit was consistent across most subgroups.
The OS of patients undergoing surgery was better than that of patients without
surgery (HR, 0.58; 95% CI, 0.35 to 0.94; P = .0001), and
there was difference in survival improvement at different surgical timings
(surgery before chemotherapy, during chemotherapy, and after chemotherapy)
(P = .0001). The survival benefit of surgery after
chemotherapy was significantly greater than that of the other 2 options (HR,
0.77; 95% CI, 0.63 to 0.94). Moreover, compared with patients with positive
margins, the OS of patients with negative margins was significantly improved
(HR, 0.22; 95% CI, 0.13 to 0.37; P < .001).
Conclusions: Our results suggest that LRT is associated with
improved OS in women with dnMBC, and patients who had surgery after systemic
chemotherapy with negative surgical margins, are expected to benefit more.
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Affiliation(s)
- Sun Jianna
- Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cang Zhou, China
| | - Kong Lingjun
- Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cang Zhou, China
| | - Feng Nana
- Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cang Zhou, China
| | - Liu Hong
- 74675Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Ren Chongxi
- Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cang Zhou, China
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Mou H, Wang Z, Zhang W, Li G, Zhou H, Yinwang E, Wang F, Sun H, Xue Y, Wang Z, Chen T, Chai X, Qu H, Lin P, Teng W, Li B, Ye Z. Clinical Features and Serological Markers Risk Model Predicts Overall Survival in Patients Undergoing Breast Cancer and Bone Metastasis Surgeries. Front Oncol 2021; 11:693689. [PMID: 34604031 PMCID: PMC8484887 DOI: 10.3389/fonc.2021.693689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022] Open
Abstract
Background Surgical therapy of breast cancer and bone metastasis can effectively improve the prognosis of breast cancer. However, after the first operation, the relationship between preoperative indicators and outcomes in patients who underwent metastatic bone surgery remained to be studied. Purpose 1. Recognize clinical and laboratory prognosis factors available to clinical doctors before the operation for bone metastatic breast cancer patients. 2. Develop a risk prediction model for 3-year postoperative survival in patients with breast cancer bone metastasis. Methods From 2014 to 2020, patients who suffered from breast cancer bone metastasis and received therapeutic procedures in our institution were included for analyses (n=145). For patients who underwent both breast cancer radical surgery and bone metastasis surgery, comprehensive datasets of the parameters of interest (clinical features, laboratory factors, and patient prognoses) were collected (n=69). We performed Multivariate Cox regression to identify factors that were associated with postoperative outcome. 3-year survival prediction model and nomograms were established by 100 bootstrapping. Its benefit was evaluated by calibration plot, C-index, and decision curve analysis. The Surveillance, Epidemiology, and End Results database was also used for external validation. Results Radiotherapy for primary cancer, pathological type of metastatic breast cancer, lymph node metastasis, elevated serum alkaline phosphatase, lactate dehydrogenase were associated with postoperative prognosis. Pathological types of metastatic breast cancer, multiple bone metastasis, organ metastases, and elevated serum lactate dehydrogenase were associated with 3-year survival. Then those significant variables and serum alkaline phosphatase counts were integrated to construct nomograms for 3-year survival. The C-statistic of the established predictive model was 0.83. The calibration plot presents a graphical representation of calibration. In the decision curve analysis, the benefits are higher than those of the extreme curve. The receiver operating characteristic of the external validation of the model was 0.82, indicating a favored fitting degree of the two models. Conclusion Our study suggests that several clinical features and serological markers can predict the overall survival among the patients who are about to receive bone metastasis surgery after breast cancer surgery. The model can guide the preoperative evaluation and clinical decision-making for patients. Level of evidence Level III, prognostic study.
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Affiliation(s)
- Haochen Mou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Wenkan Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Guoqi Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hao Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Eloy Yinwang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Fangqian Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hangxiang Sun
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Yucheng Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zenan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Tao Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Xupeng Chai
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hao Qu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Peng Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Wangsiyuan Teng
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Binghao Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
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11
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Impact of loco-regional treatment including radiotherapy in patients presenting with metastatic breast cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
The impact of loco-regional treatment (LRT) with radiotherapy (RT) in patients presenting with metastatic breast cancer (MBC) has not been widely studied. The aim of this study was to review the treatment outcomes of LRT including RT in patients with MBC.
Materials and methods:
Patients who presented with MBC were included in this retrospective study. Analysis was undertaken to determine the difference in local disease control, overall survival (OS) and progression-free survival (PFS) with systemic treatment alone, surgery alone, surgery plus RT and RT alone with long-rank test. Multivariate analysis was done, using the cox regression for factors affecting PFS and OS.
Results:
From 2007 to 2014, data of 257 patients with MBC were collected. Totally, 185 patients received LRT and 72 did not. LRT was surgery plus RT, surgery only and RT only in 113, 47 and 25 patients, respectively. Cytotoxic chemotherapy and hormone therapy were received by 205 and 166 patients, respectively. Median follow-up was 36 months (6–120 months). PFS and OS at 3 years with and without LRT were 31% versus 6% (p < 0·001) and 41% versus 17% (p < 0·001), respectively. PFS at 3 years with surgery plus RT, RT alone and surgery was 40, 33 and 6%, respectively. OS at 3 years with surgery plus RT, RT alone and surgery was 50, 38 and 17%, respectively. Patients without LRT had worse PFS and OS, 6 and 17%, respectively. RT had significant impact on PFS and OS along with chemotherapy and hormone treatment.
Conclusion:
In patients with MBC, improved local control, PFS and OS were achieved with loco-regional RT. Loco-regional RT along with chemotherapy and hormones were significant factors for PFS and OS irrespective of surgery.
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12
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Yamaguchi K, Matsunuma R, Hayami R, Tsuneizumi M. Large Breast Tumor Ulceration and Quality of Life in an 80-Year-Old Woman. Case Rep Oncol 2021; 14:580-584. [PMID: 33976637 PMCID: PMC8077448 DOI: 10.1159/000514980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Abstract
Advanced breast cancer with skin ulceration, bleeding, and odor is associated with impaired quality of life (QoL). In patients with metastatic breast cancer, treatment aims to relieve symptoms, improve QoL, and slow the progression of cancer. Occasionally, it is extremely difficult to alleviate symptoms and improve QoL in patients with breast cancer and skin ulceration, especially elderly patients. Since patient age, patient preferences, and the expected survival benefit from treatment are factors that influence the selection of therapy, physicians should provide an optimal treatment for patients with metastatic disease depending on the situation. In this study, we report the case of an elderly patient with metastatic breast cancer who had substantial skin ulceration. In this patient, multidisciplinary treatment including chemotherapy, radiotherapy, and surgery resulted in significantly improved QoL.
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Affiliation(s)
- Kei Yamaguchi
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryoichi Matsunuma
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryosuke Hayami
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
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13
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Locoregional Therapy for the Primary Tumour in Women with a De Novo Diagnosis of Metastatic Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Zhang J, Luo S, Qiu Z, Lin Y, Song C. Impact of Postoperative Radiotherapy on Survival of Patients With de novo Stage IV Breast Cancer: A Population-Based Study From the SEER Database. Front Oncol 2021; 11:625628. [PMID: 33816261 PMCID: PMC8012805 DOI: 10.3389/fonc.2021.625628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: In our study, we aimed to evaluate the role of postoperative radiotherapy for patents with de novo stage IV breast cancer. Patients and Methods: Patients diagnosed with stage IV breast cancer from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Those patients who received both chemotherapy and surgery and lived longer than 6 months were divided into radiotherapy and non-radiotherapy groups. Kaplan-Meier analysis and multivariate Cox proportional hazards models were used to estimate the survival outcomes before and after being 1:1 propensity score matched (PSM). Subgroup analyses stratified by age, subtype, status of distant metastasis, and surgery type were also performed. Results: Among 1,935 patients, 52% (1006) underwent radiotherapy while the non-radiotherapy group contained 48% (929). After PSM, a total of 1,520 patients in two groups of 760 patients were enrolled in this analysis. Kaplan-Meier and the multivariate survival analysis demonstrated that the radiotherapy group presented with a better prognosis compared to the non-radiotherapy group (after PSM, BCSS: Hazard Ratio, 0.697; 95% confidence interval, 0.59-0.823; P < 0.001; OS: Hazard Ratio, 0.707; 95% confidence interval, 0.601-0.831; P < 0.001). Further subgroup analyses showed the Luminal subtype (HR+/HER2-), triple-negative breast cancer (TNBC), and bone-only metastasis patients presented with the most promising survival in the radiotherapy group. Conclusions: Postoperative radiotherapy is associated with a significant survival advantages in BCSS and OS. It can be an optimal supplementary treatment for stage IV patients after surgery, especially for Luminal subtype, TNBC, and patients with a low metastatic burden.
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Affiliation(s)
- Jie Zhang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Breast Surgery Institute, Fujian Medical University, Fuzhou, China
| | - Shiping Luo
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhaozhen Qiu
- Department of General Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chuangui Song
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Breast Surgery Institute, Fujian Medical University, Fuzhou, China
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15
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Jacobson G, Kaidar-Person O, Haisraely O, Galper S, Rabin T, Dromi Shahadi I, Lawrence YR, Symon Z, Akiva Ben-David M. Palliative radiation therapy for symptomatic advance breast cancer. Sci Rep 2021; 11:5282. [PMID: 33674709 PMCID: PMC7970854 DOI: 10.1038/s41598-021-84872-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/16/2021] [Indexed: 12/11/2022] Open
Abstract
In this study, we evaluated the effectiveness of palliative breast radiation therapy (RT), with single fraction RT compared with fractionated RT. Our study showed that both RT fractionation schemas provide palliation. Single fraction RT allowed for treatment with minimal interference with systemic therapy, whereas fractionated RT provided a more durable palliative response. Due to equivalent palliative response, at our institution we have increasingly been providing single fraction RT palliation during the COVID-19 pandemic.
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Affiliation(s)
- Galia Jacobson
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Kaidar-Person
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, The Netherlands.
| | - Ory Haisraely
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Galper
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Tatiana Rabin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Radiation Oncology, Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yaacov Richard Lawrence
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Symon
- Radiation Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Akiva Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Assuta Medical Center, Tel Aviv, Israel
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16
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Wang J, Yang SP, Zhou P, Lian CL, Lei J, Hua L, He ZY, Wu SG. Additional radiotherapy to breast-conserving surgery is an optional treatment for de novo stage IV breast cancer: A population-based analysis. Cancer Med 2021; 10:1634-1643. [PMID: 33586323 PMCID: PMC7940213 DOI: 10.1002/cam4.3751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background We aim to assess the value of locoregional treatment (LRT) including breast‐conserving surgery (BCS), mastectomy (MAST), and radiotherapy (RT) in patients with de novo stage IV breast cancer. Methods Patients with de novo stage IV breast cancer were retrospectively identified from the Surveillance, Epidemiology, and End Results database between 2004 and 2014. Kaplan‐Meier analysis, log‐rank tests, propensity score matching (PSM), and the multivariate Cox proportional model were used for statistical analysis. Results A total of 5798 patients were identified including 849 (14.6%), 763 (13.2%), 2338 (40.3%), and 1848 (31.9%) who received BCS alone, BCS+RT, MAST alone, and MAST+RT, respectively. The proportions of receiving BCS decreased from 35.9% in 2004 to 26.2% in 2014 (p = 0.002), and the probability of patients receiving MAST increased from 64.1% in 2004 to 74.8% in 2014 (p = 0.002). Before PSM, there was a significant difference in breast cancer‐specific survival (BCSS) among the treatment arms. Patients who received RT had better BCSS, the 5‐year BCSS was 40.5%, 52.3%, 41.5%, and 47.7% in patients treated with BCS alone, BCS+RT, MAST alone, and MAST+RT, respectively (p < 0.001). In the PSM cohort, patients treated with BCS alone had lower 5‐year BCSS compared to those treated with BCS+RT (43.9% and 52.1%, p = 0.002). However, there were comparable 5‐year BCSS between BCS+RT and MAST alone groups (51.3% and 50.1%, p = 0.872), and BCS+RT and MAST+RT cohorts (51.5% and 55.7%, p = 0.333). Similar results were confirmed in multivariate analysis. Conclusions Postoperative RT improves BCSS in patients with de novo stage IV breast cancer, and BCS+RT shows a non‐inferior outcome compared to MAST+RT. BCS+RT may be the optimal local management of de novo stage IV breast cancer.
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Affiliation(s)
- Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Shi-Ping Yang
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Medical University), Haikou, Hainan, People's Republic of China
| | - Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
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17
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Lian CL, Guo LY, Zhang L, Wang J, Lei J, Hua L, He ZY, Wu SG. Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis. Front Oncol 2020; 10:522580. [PMID: 33282721 PMCID: PMC7706410 DOI: 10.3389/fonc.2020.522580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction To investigate the effect of local treatment strategy on survival outcome in de novo stage IV breast cancer patients who received chemotherapy. Methods We identified stage IV breast cancers that presented with synchronous metastasis from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan–Meier survival curves, propensity score matching (PSM), and multivariate Cox regression model were used for statistical analyses. Results We identified 5,374 patients in total, including 2,319 (43.2%), 2,137 (39.8%), and 918 (17.1%) patients who received surgery alone, surgery+radiotherapy, and radiotherapy alone, respectively. The probability of patients receiving surgery alone decreased over time, and the probability of patients receiving radiotherapy alone increased over time. However, no significant difference was observed in the probability of patients receiving postoperative radiotherapy (P = 0.291). The 3-year breast cancer-specific survival (BCSS) in patients treated with surgery alone, radiotherapy alone, and surgery+radiotherapy was 57.1, 35.9, and 63.9%, respectively (P < 0.001). The local treatment strategy was the independent prognostic factor related to BCSS. Using surgery alone as the reference, radiotherapy alone was related to lower BCSS (P < 0.001), while additional radiotherapy after surgery improved BCSS (P < 0.001). Similar results were observed using PSM. Conclusions Compared to radiotherapy alone, surgery to the primary site may confer a survival benefit in stage IV breast cancer with synchronous metastasis, and additional postoperative radiotherapy further improves outcome after primary tumor removal. Local treatment can only be an option in highly selected patients with de novo stage IV disease in the treatment guidelines. More prospective studies are needed to investigate the role of local management for this patient subset.
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Affiliation(s)
- Chen-Lu Lian
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li-Yi Guo
- The Sixth People's Hospital of Huizhou, Affiliated Huiyang Hospital of Southern Medical University, Huizhou, China
| | - Lei Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jun Wang
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China
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18
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Pons-Tostivint E, Alouani E, Kirova Y, Dalenc F, Vaysse C. Is there a role for locoregional treatment of the primary tumor in de novo metastatic breast cancer in the era of tailored therapies?: Evidences, unresolved questions and a practical algorithm. Crit Rev Oncol Hematol 2020; 157:103146. [PMID: 33227574 DOI: 10.1016/j.critrevonc.2020.103146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Improvements in systemic therapies have changed the face of de novo metastatic breast cancer (dnMBC), with a 5-year survival rate exceeding 25 %. Increasing evidence suggests that a subset of patients could benefit from a locoregional treatment (LRT) with prolonged survival, although the diversity of publications on the subject make it difficult to draw any conclusions. In this review, we summarize the available data on retrospective, prospective and current ongoing clinical trials. Since factors such as tumor biology, pattern of metastatic dissemination and the timing of the treatment are closely linked to the therapeutic strategy, we focus on papers which include these aspects. We discuss recent studies indicating that exclusive radiotherapy provides results comparable with those obtained by surgery. We will then discuss the biological rationale for LRT. Finally, we propose a decision-tree to select the optimal candidates for LRT in dnMBC patients.
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Affiliation(s)
- E Pons-Tostivint
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.
| | - E Alouani
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - Y Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - F Dalenc
- Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - C Vaysse
- Surgical Department, Toulouse University Hospital Center (CHU Toulouse), IUCT-Oncopole, 31000, Toulouse, France
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19
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Yamamoto T, Niibe Y, Aoki M, Shintani T, Yamada K, Kobayashi M, Yamashita H, Ozaki M, Manabe Y, Onishi H, Yahara K, Nishikawa A, Katsui K, Oh RJ, Terahara A, Jingu K. Analyses of the local control of pulmonary Oligometastases after stereotactic body radiotherapy and the impact of local control on survival. BMC Cancer 2020; 20:997. [PMID: 33054721 PMCID: PMC7559191 DOI: 10.1186/s12885-020-07514-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background Successful local therapy for oligometastases may lead to longer survival. The purpose of this multicentre retrospective study was to investigate factors affecting the local control (LC) of pulmonary oligometastases treated by stereotactic body radiotherapy (SBRT) and to investigate the impact of LC on survival. Methods The inclusion criteria included 1 to 5 metastases, the primary lesion and other extrathoracic metastases were controlled before SBRT, and the biological effective dose (BED10) of the SBRT was 75 Gy or more. The Cox proportional hazards model was used for analyses. Results Data of 1378 patients with 1547 tumours from 68 institutions were analysed. The median follow-up period was 24.2 months. The one-year, 3-year and 5-year LC rates were 92.1, 81.3 and 78.6%, respectively, and the 1-year, 3-year and 5-year overall survival rates were 90.1, 60.3 and 45.5%, respectively. Multivariate analysis for LC showed that increased maximum tumour diameter (p = 0.011), type A dose calculation algorithm (p = 0.005), shorter overall treatment time of SBRT (p = 0.035) and colorectal primary origin (p < 0.001 excluding oesophagus origin) were significantly associated with a lower LC rate. In the survival analysis, local failure (p < 0.001), worse performance status (1 vs. 0, p = 0.013; 2–3 vs. 0, p < 0.001), oesophageal primary origin (vs. colorectal origin, p = 0.038), squamous cell carcinoma (vs. adenocarcinoma, p = 0.006) and increased maximum tumour diameter (p < 0.001) showed significant relationships with shorter survival. Conclusions Several factors of oligometastases and SBRT affected LC. LC of pulmonary oligometastases by SBRT showed a significant survival benefit compared to patients with local failure.
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Affiliation(s)
- Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yuzuru Niibe
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.,Department of Public Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Masahiko Aoki
- Department of Radiation Oncology, Hirosaki University, 1 Bunkyo-cho, Hirosaki, 036-8560, Japan
| | - Takashi Shintani
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Kazunari Yamada
- Department of Radiation Oncology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, 433-8558, Japan
| | - Mitsuru Kobayashi
- Department of Radiation Oncology, Fukuyama City Hospital, 5-23-1 Zao-cho, Fukuyama, 721-8511, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masatoki Ozaki
- Department of Radiation Oncology, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu-ku, Shizuoka, 424-8636, Japan
| | - Yoshihiko Manabe
- Department of Radiology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroshi Onishi
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, 409-3898, Japan
| | - Katsuya Yahara
- Department of Radiology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Atsushi Nishikawa
- Department of Radiation Oncology, Shikoku Cancer Center, 160 Minamiumemoto-machi, Matsuyama, 791-0280, Japan
| | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Ryoong-Jin Oh
- Department of Radiology, Miyakojima IGRT Clinic, 1-16-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Atsuro Terahara
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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20
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Ghannam Y, Bourgier C, Legouté F, Gonzalez-Moya A, Lizée T, Trémolières P, Hennequin C. [Treatment of primary disease with irradiation in case of de novo metastatic breast cancer]. Cancer Radiother 2020; 24:567-575. [PMID: 32814669 DOI: 10.1016/j.canrad.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022]
Abstract
Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
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Affiliation(s)
- Y Ghannam
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France.
| | - C Bourgier
- Université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Fédération universitaire d'oncologie radiothérapie, Institut régional du cancer de Montpellier (ICM), rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier IRCM, avenue des Apothicaires, 34298 Montpellier cedex 05, France; Inserm, U1194, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - F Legouté
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - A Gonzalez-Moya
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - T Lizée
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - P Trémolières
- Département de radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 15, rue André-Boquel, 49100 Angers, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris, France
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21
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Yoshimura M. Radiation therapy for primary tumor of de novo stage IV breast cancer. Transl Cancer Res 2020; 9:5108-5116. [PMID: 35117877 PMCID: PMC8797856 DOI: 10.21037/tcr.2020.02.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022]
Abstract
Despite recent advances in multimodality treatments such as endocrine therapy, chemotherapy, molecularly targeted therapy, and radiation therapy, it is still very difficult to cure de novo stage IV breast cancer patients completely. The traditional role of radiation therapy for these patients has been a palliative treatment strategy that aims to control tumor progression and suppress tumor related symptoms. Recently, several non-randomized retrospective studies on de novo stage IV breast cancer have revealed that locoregional radiation therapy (LRRT) might confer a survival benefit. However, there is no high level evidence to support the impact of LRRT on survival among patients with de novo metastatic disease so far. This article aimed to summarize the literature and to discuss whether treating the primary lesion with radiation therapy could improve clinical survival outcomes among de novo stage IV breast cancer patients. The issue of patient selection will be discussed because not all de novo stage IV breast cancer patients could benefit from LRRT. This article also explores the clinical evidence regarding LRRT for de novo metastatic disease across various cancers such as prostate, uterine cervical, non-small-cell lung, and head and neck cancers. Many retrospective trials have shown the impact of locoregional treatment (LRT) on survival in de novo metastatic breast cancer. However, since the backgrounds of patients treated with LRRT are quite different from those of patients who did not receive LRRT and the treatment consists of surgery and/or radiation therapy, the role of radiation therapy alone remains unclear. Several reports investigated prognostic factors to detect the benefits of LRRT, which still remains conflicting and no consensus exists. However, selected patients with de novo metastatic disease with better performance status, low tumor burden, and estrogen receptor positivity should be considered for the addition of radiation therapy delivered to the primary site. To explore proper decision-making regarding LRRT, further prospective randomized trials are eagerly awaited.
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Affiliation(s)
- Michio Yoshimura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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22
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Tang É, Nguyen TVF, Clatot F, Rambeau A, Johnson A, Sun XS, Tao Y, Thariat J. Radiation therapy on primary tumour of synchronous metastatic head and neck squamous cell carcinomas. Cancer Radiother 2020; 24:559-566. [PMID: 32753240 DOI: 10.1016/j.canrad.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/22/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Patients with synchronous metastatic head and neck squamous cell carcinomas often present associated locoregional symptoms and a risk of life-threatening primary tumour progression. Few data have been published about the use of radiation therapy in the management of newly diagnosed metastatic disease associated with advanced locoregional disease. In this article, we aim to determine the role of radiation therapy of the primary tumour in the overall therapeutic strategy for these diseases. We further address radiation therapy modalities (technique, volumes, and fractionation) in such a context. MATERIAL AND METHODS We conducted a literature survey on locoregional radiotherapy for newly diagnosed metastatic head and neck squamous cell carcinomas. RESULTS Several retrospective studies have reported that locoregional radiotherapy is associated with improved overall survival of patients with synchronous metastatic head and neck squamous cell carcinomas. However, data about modalities such as timing of radiotherapy in the overall strategy, dose, fractionation and delineation volumes are scarce. Two schematic situations can be distinguished with respect to prognosis and treatment adaptations: polymetastatic/bulky or oligometastatic disease. In polymetastic/bulky disease associated with poor prognosis, standard-of-care is systemic therapy, but locoregional radiotherapy can be discussed either upfront, mainly for symptomatic palliation, or as consolidation after downsizing obtained by systemic therapy. As for oligometastatic disease, with the rise in use of efficacious and well-tolerated local ablative treatments of metastases, aggressive curative-intent locoregional radiotherapy can be considered with or without systemic therapy. CONCLUSION Because locoregional disease is a major cause of disease failure in patients with synchronous metastatic head and neck squamous cell carcinomas, aggressive locoregional radiation therapy to the primary tumour may be discussed in the initial management of the disease where systemic therapy alone may not induce sufficient primary tumour reduction. With recent technological advances in radiotherapy, the delivery of radiotherapy is safe and feasible even in metastatic setting. Clinical trials assessing radiotherapy use for metastatic head and neck squamous cell carcinomas are warranted.
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Affiliation(s)
- É Tang
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - T-V-F Nguyen
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - F Clatot
- Département d'oncologie médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - A Rambeau
- Département d'oncologie médicale, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - A Johnson
- Département d'oncologie médicale, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France
| | - X S Sun
- Département de radiothérapie, hôpital Nord-Franche-Comté, site du Mittan, 1, rue Henri-Becquerel, 25209 Montbéliard, France
| | - Y Tao
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France.
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23
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Tsukioki T, Shien T, Doihara H. Effect of local surgery on outcomes of stage IV breast cancer. Transl Cancer Res 2020; 9:5102-5107. [PMID: 35117876 PMCID: PMC8798833 DOI: 10.21037/tcr.2020.01.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/16/2020] [Indexed: 01/22/2023]
Abstract
Metastatic breast cancer (MBC), including de novo stage IV, is regarded as being incurable and the mainstay of clinical management is systemic therapy. Traditionally, locoregional surgery is performed only for local control, such as to prevent ulceration and bleeding. In recent years, however, both retrospective and prospective studies have demonstrated the prognostic efficacy of primary surgery for de novo stage IV patients. Therefore, we conducted a meta-analysis to evaluate whether surgical therapy contributes to overall survival (OS) extension. We searched for clinical trials published in electronic databases (PubMed, Embase, and the Cochrane databases) and performed a meta-analysis of the data collected. There were five prospective randomized controlled phase III trials (RCTs). The results of three have been reported. According to our meta-analysis of these RCTs, primary surgery for de novo stage IV breast cancer patients significantly improves OS. However, the Tata trial showed that systemic therapy does not achieve a sufficient effect. Another trial, conducted in Turkey, had statistical shortcomings and patient randomization was not adequately performed The ABCSG (Austrian Breast and Colorectal Cancer Study Group) trial had too few subjects. Meta-analysis of 12 retrospective studies showed that patients with stage IV breast cancer receiving surgery as the initial treatment experienced longer OS (HR: 0.65, P<0.00001). Based on our meta-analysis of three reported RCTs, surgery as the primary treatment does not significantly impact the outcomes of de novo stage IV breast cancer patients. However, these trials had limitations. We await the results of the remaining two ongoing RCTs (ECOG 2108 and JCOG 1017). These trials are anticipated to resolve current controversies and provide many eagerly awaited answers.
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Affiliation(s)
- Takahiro Tsukioki
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Hiroyoshi Doihara
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, 700-8558, Japan
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24
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Pons-Tostivint E, Kirova Y, Lusque A, Campone M, Geffrelot J, Rivera S, Mailliez A, Pasquier D, Madranges N, Firmin N, Crouzet A, Gonçalves A, Jankowski C, De La Motte Rouge T, Pouget N, De La Lande B, Mouttet-Boizat D, Ferrero JM, Uwer L, Eymard JC, Mouret-Reynier MA, Petit T, Courtinard C, Filleron T, Robain M, Dalenc F. Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis. Radiother Oncol 2020; 145:109-116. [DOI: 10.1016/j.radonc.2019.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
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25
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Wang Z, Cheng Y, Chen S, Shao H, Chen X, Wang Z, Wang Y, Zhou H, Chen T, Lin N, Ye Z. Novel prognostic nomograms for female patients with breast cancer and bone metastasis at presentation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:197. [PMID: 32309344 PMCID: PMC7154431 DOI: 10.21037/atm.2020.01.37] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background There is a paucity of literature about prognostic evaluation for patients with breast cancer (BC) and bone metastasis at presentation. To date, little is known about how to accurately predict the prognosis of BC patients with bone metastasis at presentation. Thus, an accurate prediction tool of prognosis in this population is urgently needed. Our goal is to construct novel and prognostic nomograms for BC patients with bone metastasis at presentation. Methods We searched Surveillance, Epidemiology, and End Results (SEER) database for BC patients with bone metastasis at presentation between 2010 and 2016. Multivariate analysis was performed to obtain significantly independent variables. Then, novel prognostic nomograms were constructed based on those independent predictors. Results Tumor grade, histological type, primary tumor size, tumor subtype, surgery, chemotherapy and number of metastatic organs except bone were recognized as significantly independent variables of both overall survival (OS) and cancer-specific survival (CSS). Then those significant variables were integrated to construct nomograms for 3- and 5-year survival. Calibration plots for the 3- and 5-year survival in training and validation sets showed that the prediction curve was close to a 45 degree slash. The C-indices of OS in training and validation cohorts were 0.705 and 0.678, respectively. Similar results were observed for CSS in training and validation cohorts. Conclusions Our proposed nomograms can effectively and accurately predict the prognosis of BC patients with bone metastasis at presentation, which provide a basis for individual treatments for metastatic lesions.
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Affiliation(s)
- Zhan Wang
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Yonggang Cheng
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Shi Chen
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.,Department of Orthopaedics, Ninghai First Hospital, Ninghai 315600, China
| | - Haiyu Shao
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Xiaowei Chen
- Department of Orthopaedics, Jingning Shezu Autonomous County People's Hospital, Lishui 323500, China
| | - Zenan Wang
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Yucheng Wang
- Graduate School of Hebei North University, Zhangjiakou 075000, China
| | - Hao Zhou
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Tao Chen
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Nong Lin
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Zhaoming Ye
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
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26
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Gera R, Chehade HELH, Wazir U, Tayeh S, Kasem A, Mokbel K. Locoregional therapy of the primary tumour in de novo stage IV breast cancer in 216 066 patients: A meta-analysis. Sci Rep 2020; 10:2952. [PMID: 32076063 PMCID: PMC7031518 DOI: 10.1038/s41598-020-59908-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy. However, there is mounting evidence that resection of the primary tumour and/or localised radiotherapy (locoregional therapy; LRT) could be associated with overall survival improvements. We aimed to conduct a meta-analysis to inform decision making. Using the PubMed, Cochrane and Ovid SP databases, a literature review and meta-analysis were conducted to assess the effect of LRT on overall survival. Studies were analysed for the impact of LRT on survival. All forms of LRT resulted in a significant 31.8% reduction in mortality (N = 42; HR = 0.6823 (95% CI 0.6365; 0.7314)). Surgical resection resulted in a significant 36.2% reduction in mortality (N = 37; HR = 0.6379 (95% CI 0.5974; 0.6811)). The prospective trials reported a 19.23% reduction in mortality which was not statistically significant (N = 3, HR = 0.8077 (95% CI 0.5704; 1.1438). 216 066 patients were included. This is the largest meta-analysis regarding this question to date. Our meta-analysis shows that LRT of the primary tumour seems to improve overall survival in de novo stage IV disease. Therefore, this therapeutic option should be considered in selected patients after a careful multidisciplinary discussion.
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Affiliation(s)
- Ritika Gera
- The London Breast Institute, Princess Grace Hospital, London, UK
| | | | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Salim Tayeh
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Abdul Kasem
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, UK.
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27
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Kim KN, Qureshi MM, Huang D, Ko NY, Cassidy M, Oshry L, Hirsch AE. The Impact of Locoregional Treatment on Survival in Patients With Metastatic Breast Cancer: A National Cancer Database Analysis. Clin Breast Cancer 2020; 20:e200-e213. [PMID: 32089454 DOI: 10.1016/j.clbc.2019.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/06/2019] [Accepted: 12/24/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although systemic therapy is the standard treatment for metastatic breast cancer, the value of locoregional treatment (LRT) of the primary tumor and its impact on survival is controversial. This study evaluates survival outcomes in patients with metastatic breast cancer after receiving LRT (surgery and/or radiation therapy) of the primary tumor. MATERIALS AND METHODS The National Cancer Database was used to identify 16,128 qualifying cases of metastatic breast cancer who received systemic therapy with or without LRT from 2004 to 2013. Treatment modality was divided into surgery (Sx), radiation therapy (RT), surgery followed by RT (Sx + RT), and no LRT. The median survival and 3-year actuarial survival rates (OS) were analyzed for each treatment group. On multivariate analyses, adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox regression modeling to adjust for patient and clinicopathologic characteristics. RESULTS Overall, the median follow-up was 28.3 months, and the median survival for all patients was 37.2 months. With 9761 deaths reported, the estimated 3-year OS was 51.3%. The Sx + RT group (n = 2166) had the highest 3-year OS of 69.4%, followed by the Sx group (n = 4293) with 57.6%, the no LRT group (n = 8955) with 44.3%, and the RT group (n = 714) with 41.5% (P < .0001). On multivariate analysis, compared with the no LRT group, a decreased HR was noted in patients receiving Sx (adjusted HR, 0.68; 95% CI, 0.65-0.71; P < .0001) and Sx + RT (adjusted HR, 0.46; 95% CI, 0.43-0.49; P < .0001). CONCLUSION LRT, especially surgery followed by RT, in addition to systemic therapy, was associated with improved survival in patients with metastatic breast cancer.
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Affiliation(s)
- Kristine N Kim
- Department of Radiation Oncology, Boston Medical Center, Boston, MA; Present affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - Daniel Huang
- Department of Radiation Oncology, Boston Medical Center, Boston, MA
| | - Naomi Y Ko
- Department of Hematology Oncology, Boston Medical Center, Boston, MA
| | | | - Lauren Oshry
- Department of Hematology Oncology, Boston Medical Center, Boston, MA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston, MA.
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28
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Nair VJ, Caudrelier JM. Hypofractionated radiotherapy for elderly breast cancer patients: from early stages disease to local palliation for unresectable disease. Transl Cancer Res 2020; 9:S189-S196. [PMID: 35117962 PMCID: PMC8799247 DOI: 10.21037/tcr.2019.09.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/09/2019] [Indexed: 12/02/2022]
Abstract
There is a lack of clear guidelines on optimal radiotherapy dose regimen for elderly breast cancer patients. This review summarizes the current evidence on role of hypofractionated radiotherapy in elderly breast cancer. Also, suggestions have been provided on the best fractionation approaches based on current evidence. Hypofractionated radiotherapy is feasible and well tolerated in elderly breast cancer patients with both early and locally advanced disease. Ultra-hypofractionated regimen seem appropriate for palliation of unresectable primary breast disease and could become a safe approach for adjuvant treatments. Hypofractionated radiotherapy should be considered for treatment of elderly breast cancer for curative intent, as well as for palliation.
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Affiliation(s)
- Vimoj J Nair
- University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1N 6N5, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1N 6N5, Canada.,Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Jean Michel Caudrelier
- University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1N 6N5, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1N 6N5, Canada
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29
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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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Traitement de la maladie primitive (cancers du sein, du poumon non à petites cellules et de la prostate), par irradiation, au stade d’emblée métastatique. Cancer Radiother 2019; 23:486-495. [DOI: 10.1016/j.canrad.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
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Toxicity of locoregional radiotherapy in combination with bevacizumab in patients with non-metastatic breast cancer (TOLERAB): Final long-term evaluation. PLoS One 2019; 14:e0221816. [PMID: 31469859 PMCID: PMC6716668 DOI: 10.1371/journal.pone.0221816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/15/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Few data are available concerning the safety of bevacizumab (B) in combination with locoregional radiation therapy (RT). The objective of this study was to evaluate the 5-year late toxicity of concurrent B and RT in non-metastatic breast cancer. MATERIALS AND METHODS This multicentre prospective study included non-metastatic breast cancer patients enrolled in phase 3 clinical trials evaluating B with concurrent RT versus RT alone. All patients received neoadjuvant or adjuvant chemotherapy and normofractionated breast or chest wall RT, with or without regional lymph node RT. B was administered at an equivalent dose of 5 mg/kg once a week for 1 year. The safety profile was evaluated 1, 3 and 5 years after completion of radiotherapy. RESULTS A total of 64 patients were included between November 2007 and April 2010. Median follow-up was 60 months (12-73) and 5-year late toxicity data were available for 46 patients. The majority of tumours were triple-negative (68.8%), tumour size <2cm (41.3%) with negative nodal status (50.8%). Median total dose of B was 15,000mg and median duration was 11.2 months. No grade ≥3 toxicity was observed. Only 8 patients experienced grade 1-2 toxicities: n = 3 (6.5%) grade 1 lymphedema, n = 2 (4.3%) grade 1 pain, n = 1 (2.2%) grade 2 lymphedema, n = 1 (2.2%) grade 1 fibrosis. Five-year overall survival was 93.8%, disease-free survival was 89% and locoregional recurrence-free survival was 93.1%. CONCLUSION Concurrent B and locoregional RT are associated with acceptable 5-year toxicity in patients with non-metastatic breast cancer. No grade ≥3 toxicity was observed.
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Cushman TR, Caetano MS, Welsh JW, Verma V. Overview of ongoing clinical trials investigating combined radiotherapy and immunotherapy. Immunotherapy 2019; 10:851-0. [PMID: 30073899 DOI: 10.2217/imt-2018-0019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Given the unprecedentedly rapid progression of clinical immuno-oncology, evaluation of currently ongoing and upcoming clinical trials is essential to address potential deficiencies for future trial design. This observational study examined trends in the current landscape of clinical trials investigating immunotherapy with radiotherapy (iRT). The National Institute of Health's clinicaltrials.gov database was queried for trials including radiation and one of the six currently US FDA approved immunotherapy drugs: ipilimumab, nivolumab, pembrolizumab, durvalumab, atezolizumab and avelumab. This study highlights that the construction of prospective iRT trials is rapidly escalating. This study provides a framework to not only understand ongoing multidisciplinary trials, but also for prudent iRT trial design in the future.
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Affiliation(s)
- Taylor R Cushman
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mauricio S Caetano
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - James W Welsh
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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The Impact of Epidemiological Factors and Treatment Interventions on Survival in Patients With Signet Ring Cell Carcinoma of the Pancreas. Am J Clin Oncol 2019; 41:1176-1184. [PMID: 29672365 DOI: 10.1097/coc.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Primary pancreatic signet ring cell carcinoma (SRCC) is a rare histologic variant of pancreatic carcinoma. A population-based analysis of pancreatic SRCC was performed to determine the predictive effects of epidemiological factors and treatment interventions on overall survival (OS) and disease-specific survival (DSS). MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results registry was searched for pancreatic SRCC cases diagnosed between January 1, 1973 and December 31, 2013. Statistical analysis was performed using the Fisher exact test, χ(2) analysis, Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. RESULTS The mean age among 497 patients was 66.6 years (SD, 11.9). Most patients were white (82.7%) and male (54.5%). The 1-, 2-, and 5-year OS rates were 17%, 9%, and 4%, respectively, while the corresponding 1-, 2-, and 5-year rates for DSS were 18%, 10%, and 5%, respectively. On univariable analysis; age, site, grade, stage, and treatment were predictive of OS and DSS (P<0.05). On multivariable analysis; radiation improved OS and DSS (adjusted hazard ratio [aHR], 0.592 and 0.589, respectively), pancreatectomy improved OS and DSS (aHR, 0.360 and 0.355, respectively), and combination therapy improved OS and DSS (aHR, 0.295 and 0.286, respectively). Age, site, and stage were also independent predictors of OS and DSS. Subgroup analysis demonstrated treatment to be an independent predictor of OS and DSS in localized/regional disease, in distant disease, and in patients diagnosed between 2000 and 2013. CONCLUSIONS Age, site, stage, and treatment independently predict OS and DSS in pancreatic SRCC.
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Kim YJ, Jung SY, Kim K. Survival benefit of radiotherapy after surgery in de novo stage IV breast cancer: a population-based propensity-score matched analysis. Sci Rep 2019; 9:8527. [PMID: 31189932 PMCID: PMC6561914 DOI: 10.1038/s41598-019-45016-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022] Open
Abstract
The survival benefit from radiotherapy in stage IV breast cancer has not been fully evaluated. We investigated the survival benefit of radiotherapy after surgery in de novo stage IV breast cancer. Using a population-based database (the Surveillance, Epidemiology, and End Results database 18, 2010-2013), patients diagnosed with de novo stage IV breast cancer were divided into those undergoing surgery alone (no-radiotherapy group) and those undergoing surgery followed by radiotherapy (radiotherapy group). After propensity-score matching (PSM), the cancer-specific survival (CSS) rates were estimated. Multivariate analysis was performed to evaluate the prognostic value of radiotherapy on survival. After PSM, the 3-year CSS rates in the no-radiotherapy (n = 882) and radiotherapy (n = 882) groups were 57.1% and 70.9% (P < 0.001), respectively. On multivariate analysis, radiotherapy after surgery was a significant prognosticator (hazard ratio [HR] 0.572; 95% confidence interval [CI] 0.472-0.693, P < 0.001). Regardless of surgery type and lymph node involvement, the radiotherapy group showed significantly higher CSS rates. For patients who survived six months or more, radiotherapy after surgery demonstrated favorable prognosis compared to surgery alone (HR 0.593; 95% CI 0.479-0.733, P < 0.001). In conclusion, radiotherapy after surgery increased CSS rates in de novo stage IV breast cancer compared to surgery alone.
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Affiliation(s)
- Yi-Jun Kim
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
- Department of Radiation Oncology, Graduate School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
- Department of Radiation Oncology, Graduate School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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Lim SM, Kim JY, Park HS, Park S, Kim GM, Sohn J, Kim SI. Effect of primary tumor resection on overall survival in patients with stage IV breast cancer. Breast J 2019; 25:908-915. [PMID: 31187565 DOI: 10.1111/tbj.13344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 12/29/2022]
Abstract
We aimed to evaluate the effect of primary tumor resection on overall survival in stage IV breast cancer patients. In total, 284 breast cancer patients presenting with breast cancer at stage IV at initial diagnosis, between 2001 and 2014, were enrolled in the study. Patients were divided into two groups based on surgical resection of the primary tumor. Overall survival (OS) between the two groups was analyzed. Patients in the surgery group (n = 92) had smaller tumors than those in the no-surgery group (n = 192, T0-1:17.7% vs 34.8%, P < 0.001). The surgery group more often had negative nodal status (5.7% vs 33.7%, P < 0.001). Multiple metastatic organ sites were more common in the no-surgery group than in the surgery group (55.7% vs 15.2%, P < 0.001). The surgery group showed a better OS than the no-surgery group (P = 0.01). Multivariate analysis showed that surgical resection of primary tumors tended to be associated with improved OS (HR = 0.67, P = 0.055). T stage, ER, HER2 and metastatic organ sites were independent prognostic factors for OS in multivariate analysis. Surgical resection of the primary tumor may be a treatment option for patients with stage IV disease and may not have a negative effect on overall survival.
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Affiliation(s)
- Sung Mook Lim
- Department of Surgery, Yonsei University College of Medicine, Seodaemoon-gu, 03722, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seodaemoon-gu, 03722, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seodaemoon-gu, 03722, Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seodaemoon-gu, 03722, Korea
| | - Gun Min Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Joohyuk Sohn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seodaemoon-gu, 03722, Korea
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Bottero M, Cancelli A, Alì E, Ponti E, Lancia A, Santoni R, Ingrosso G. Post-operative radiotherapy in the management of metastatic inflammatory breast cancer. JOURNAL OF ONCOLOGICAL SCIENCES 2019. [DOI: 10.1016/j.jons.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Roayaei M, Nikanpour Y, Mahdavi H. Effect of Surgery or Radiotherapy of the Breast on Survival in Metastatic Disease: a Retrospective Cohort Study. Indian J Surg Oncol 2019; 10:213-218. [PMID: 30948902 PMCID: PMC6414585 DOI: 10.1007/s13193-018-0830-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
Evidence to justify survival benefit of local therapy of the breast (LT) for breast cancer patients who are metastatic at presentation (MBC) is weak. The aim of this study is to evaluate the outcome of LT on survival in MBC patients. Patients who had received (1) radiotherapy, (2) surgery, (3) surgery and radiotherapy as LT, and (4) no LT in four groups of 25 were evaluated for 1- and 4-year cause-specific survival (CSS). One- and 4-year CSS in four groups were (1) 76% and 60%, (2) 84% and 56% (3) 80% and 52%, and (4) 48% and 16%, respectively. When controlling for age and site of metastasis as covariates, grouping significantly correlated with survival: F (3, 94): 2.93, P 0.04. Post hoc analysis revealed that the mean survival of group 2: (M 23.39, SE 2.53) was higher than group 4: (M 13.63, SE 2.52, P = 0.03). Surgery as a single modality LT for MBC may provide survival benefit.
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Affiliation(s)
- Mahnaz Roayaei
- Department of Radiotherapy and Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yalda Nikanpour
- Najaf-Abad Branch, Faculty of Medicine, Islamic Azad University, Isfahan, Iran
| | - Hoda Mahdavi
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran
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Pons-Tostivint E, Kirova Y, Lusque A, Campone M, Geffrelot J, Mazouni C, Mailliez A, Pasquier D, Madranges N, Firmin N, Crouzet A, Gonçalves A, Jankowski C, De La Motte Rouge T, Pouget N, de La Lande B, Mouttet-Boizat D, Ferrero JM, Uwer L, Eymard JC, Mouret-Reynier MA, Petit T, Robain M, Filleron T, Cailliot C, Dalenc F. Survival Impact of Locoregional Treatment of the Primary Tumor in De Novo Metastatic Breast Cancers in a Large Multicentric Cohort Study: A Propensity Score-Matched Analysis. Ann Surg Oncol 2018; 26:356-365. [DOI: 10.1245/s10434-018-6831-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Indexed: 12/16/2022]
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Tanić M, Krivokuća A, Čavić M, Mladenović J, Plesinac Karapandžić V, Beck S, Radulović S, Susnjar S, Janković R. Molecular signature of response to preoperative radiotherapy in locally advanced breast cancer. Radiat Oncol 2018; 13:193. [PMID: 30285791 PMCID: PMC6167820 DOI: 10.1186/s13014-018-1129-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/12/2018] [Indexed: 01/07/2023] Open
Abstract
Background Radiation therapy is an indispensable part of various treatment modalities for breast cancer. Specifically, for non-inflammatory locally advanced breast cancer (LABC) patients, preoperative radiotherapy (pRT) is currently indicated as a second line therapy in the event of lack of response to neoadjuvant chemotherapy. Still approximately one third of patients fails to respond favourably to pRT. The aim of this study was to explore molecular mechanisms underlying differential response to radiotherapy (RT) to identify predictive biomarkers and potential targets for increasing radiosensitivity. Methods The study was based on a cohort of 134 LABC patients, treated at the Institute of Oncology and Radiology of Serbia (IORS) with pRT, without previous or concomitant systemic therapy. Baseline transcriptional profiles were established using Agilent 60 K microarray platform in a subset of 23 formalin-fixed paraffin-embedded (FFPE) LABC tumour samples of which 11 radiotherapy naïve and 3 post-radiotherapy samples passed quality control and were used for downstream analysis. Biological networks and signalling pathways underlying differential response to RT were identified using Ingenuity Pathways Analysis software. Predictive value of candidate genes in the preoperative setting was further validated by qRT-PCR in an independent subset of 60 LABC samples of which 42 had sufficient quality for data analysis, and in postoperative setting using microarray data from 344 node-negative breast cancer patients (Erasmus cohort, GSE2034 and GSE5327) treated either with surgery only (20%) or surgery with RT (80%). Results We identified 192 significantly differentially expressed genes (FDR < 0.10) between pRT-responsive and non-responsive tumours, related to regulation of cellular development, growth and proliferation, cell cycle control of chromosomal replication, glucose metabolism and NAD biosynthesis II route. APOA1, MAP3K4, and MMP14 genes were differentially expressed (FDR < 0.20) between pRT responders and non-responders in preoperative setting, while MAP3K4 was further validated as RT-specific predictive biomarker of distant metastasis free survival (HR = 2.54, [95%CI:1.42–4.55], p = 0.002) in the postoperative setting. Conclusions This study pinpoints MAP3K4 as a putative biomarker of response to RT in both preoperative and postoperative settings and a potential target for radiosensitising combination therapy, warranting further pre-clinical studies and prospective clinical validation. Electronic supplementary material The online version of this article (10.1186/s13014-018-1129-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miljana Tanić
- Laboratory for Molecular Genetics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia. .,Medical Genomics, UCL Cancer Institute, University College London, London, UK.
| | - Ana Krivokuća
- Laboratory for Molecular Genetics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Milena Čavić
- Laboratory for Molecular Genetics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Jasmina Mladenović
- Radiology and Radiotherapy Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Stephan Beck
- Medical Genomics, UCL Cancer Institute, University College London, London, UK
| | - Siniša Radulović
- Laboratory for Molecular Genetics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Snezana Susnjar
- Medical Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Radmila Janković
- Laboratory for Molecular Genetics, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
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Xiao W, Zou Y, Zheng S, Hu X, Liu P, Xie X, Yu P, Tang H, Xie X. Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2018; 44:1504-1512. [DOI: 10.1016/j.ejso.2018.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022] Open
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Radiation therapy to the primary in metastatic prostate cancer: palliation only or altering tumor biology? Curr Opin Urol 2018; 27:580-586. [PMID: 28816713 DOI: 10.1097/mou.0000000000000444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite improvement in systemic treatment, the prognosis of men with de novo metastatic prostate cancer remains poor. Treating the local disease may not only reduce the occurrence of local urologic symptoms, but also slow the metastatic process, either by reducing the seeding from the primary tumor or by altering the microenvironment and thus minimizing the formation of new metastatic sites. RECENT FINDINGS Retrospective and population-based studies have suggested that the addition of local treatment to systemic therapy may improve survival in this patient group. The aim of this review is to discuss the biologic rationale of such an approach, present and discuss the current available evidence, with a focus on radiation-based treatments. It is key to also address the issue of patient selection as not all patients with metastatic prostate cancer will benefit from the treatment of the primary tumor. SUMMARY Retrospective and population-based research suggests a survival benefit of prostatectomy or radiotherapy in metastatic prostate cancer patients. Clinical trials evaluating the role of prostate radiotherapy in the metastatic setting are ongoing.
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Dautruche A, Belin L, Cottu P, Bontemps P, Lemanski C, de la Lande B, Baumann P, Missohou F, Lévy C, Peignaux K, Reynaud-Bougnoux A, Denis F, Gobillion A, Pernin V, Kirova Y. Evaluation at 3 years of concurrent bevacizumab and radiotherapy for breast cancer: Results of a prospective study. Cancer Radiother 2018; 22:222-228. [PMID: 29650388 DOI: 10.1016/j.canrad.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/04/2017] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the 3 years late toxicity among patients with non-metastatic breast cancer who received concurrent bevacizumab and locoregional radiotherapy. MATERIAL AND METHODS This is a single-arm, multicentre, prospective study, of the toxicity of adjuvant concomitant association of bevacizumab and radiotherapy in patients with breast cancer. Toxicity was assessed by the Common Terminology Criteria for Adverse Events version 3.0 during the radiotherapy and follow-up clinics at 12 and 36 months after its completion. The study was designed to evaluate the toxicity at one year, 3 years and 5 years. RESULTS Sixty-four patients were included from October 2007 to August 2010. All of them received concurrent adjuvant radiotherapy and bevacizumab (in 24 cases after primary systemic treatment). All patients received non-fractionated radiotherapy to breast or chest wall with or without irradiation of regional lymph nodes. Early toxicity has been previously reported. Median follow-up was 46.4 months (range: 18-77 months). Median age was 53 years old (range: 23-68 years). The 3-years overall survival was 93% (range: 87-100%). Evaluation of the toxicity at 3 years was available for 67% of the patients. There was a low rate of toxicity: 14% grade 1 pain, 9% grade 1 fibrosis, 2% grade 1 telangiectasia, 2% grade 1 paresis, 7% grade 1 lymphedema and 2% grade 3 lymphedema. No grade 4 toxicity was observed. No patient had a left ventricular ejection fraction below 50% at 3 years. CONCLUSIONS Concurrent bevacizumab with locoregional radiotherapy is associated with acceptable 3-years toxicity in patients with breast cancer.
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Affiliation(s)
- A Dautruche
- Radiotherapy department, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - L Belin
- Biostatistics department, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - P Cottu
- Oncology department, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - P Bontemps
- Radiotherapy department, CHU Jean-Minjoz, 25030 Besançon, France
| | - C Lemanski
- Radiotherapy department, institut régional du cancer de Montpellier, 34298 Montpellier, France
| | - B de la Lande
- Radiotherapy department, institut Curie, René-Huguenin hospital, 92210 Saint-Cloud, France
| | - P Baumann
- Radiotherapy department, centre d'oncologie de Gentilly, 54000 Nancy, France
| | - F Missohou
- Radiotherapy department, centre Henri-Becquerel, 76038 Rouen, France
| | - C Lévy
- Radiotherapy department, centre François-Baclesse, 14000 Caen, France
| | - K Peignaux
- Radiotherapy department, centre Georges-François-Leclerc, 21079 Dijon, France
| | | | - F Denis
- Radiotherapy department, centre Jean-Bernard, 72000 Le Mans, France
| | - A Gobillion
- Biostatistics department, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - V Pernin
- Radiotherapy department, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Radiotherapy department, institut Curie, 26, rue d'Ulm, 75005 Paris, France
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Abstract
BACKGROUND Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Surgery to remove the primary tumour is associated with an increased survival in other types of metastatic cancer. Breast surgery is not standard treatment for metastatic disease, however several recent retrospective studies have suggested that breast surgery could increase the women's survival. These studies have methodological limitations including selection bias. A systematic review mapping all randomised controlled trials addressing the benefits and potential harms of breast surgery is ideal to answer this question. OBJECTIVES To assess the effects of breast surgery in women with metastatic breast cancer. SEARCH METHODS We conducted searches using the MeSH terms 'breast neoplasms', 'mastectomy', and 'analysis, survival' in the following databases: the Cochrane Breast Cancer Specialised Register, CENTRAL, MEDLINE (by PubMed) and Embase (by OvidSP) on 22 February 2016. We also searched ClinicalTrials.gov (22 February 2016) and the WHO International Clinical Trials Registry Platform (24 February 2016). We conducted an additional search in the American Society of Clinical Oncology (ASCO) conference proceedings in July 2016 that included reference checking, citation searching, and contacting study authors to identify additional studies. SELECTION CRITERIA The inclusion criteria were randomised controlled trials of women with metastatic breast cancer at initial diagnosis comparing breast surgery plus systemic therapy versus systemic therapy alone. The primary outcomes were overall survival and quality of life. Secondary outcomes were progression-free survival (local and distant control), breast cancer-specific survival, and toxicity from local therapy. DATA COLLECTION AND ANALYSIS Two review authors independently conducted trial selection, data extraction, and 'Risk of bias' assessment (using Cochrane's 'Risk of bias' tool), which a third review author checked. We used the GRADE tool to assess the quality of the body of evidence. We used the risk ratio (RR) to measure the effect of treatment for dichotomous outcomes and the hazard ratio (HR) for time-to-event outcomes. We calculated 95% confidence intervals (CI) for these measures. We used the random-effects model, as we expected clinical or methodological heterogeneity, or both, among the included studies. MAIN RESULTS We included two trials enrolling 624 women in the review. It is uncertain whether breast surgery improves overall survival as the quality of the evidence has been assessed as very low (HR 0.83, 95% CI 0.53 to 1.31; 2 studies; 624 women). The two studies did not report quality of life. Breast surgery may improve local progression-free survival (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; low-quality evidence), while it probably worsened distant progression-free survival (HR 1.42, 95% CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence). The two included studies did not measure breast cancer-specific survival. Toxicity from local therapy was reported by 30-day mortality and did not appear to differ between the two groups (RR 0.99, 95% CI 0.14 to 6.90; 1 study; 274 women; low-quality evidence). AUTHORS' CONCLUSIONS Based on existing evidence from two randomised clinical trials, it is not possible to make definitive conclusions on the benefits and risks of breast surgery associated with systemic treatment for women diagnosed with metastatic breast cancer. Until the ongoing clinical trials are finalised, the decision to perform breast surgery in these women should be individualised and shared between the physician and the patient considering the potential risks, benefits, and costs of each intervention.
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Affiliation(s)
- Giuliano Tosello
- Iamada HospitalCassemiro Boscoli 236, Jd IcarayPresidente PrudenteSao PauloBrazil19060‐530
| | - Maria Regina Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSão PauloBrazil04038‐000
| | - Bruna S Mota
- Instituto do câncer de São Paulo (ICESP/FMUSP)Department of Obstetrics and GynecologyAv. Dr Arnaldo 251Sao PauloSao PauloBrazil01246‐000
| | - Teresa Neeman
- The Australian National UniversityStatistical Consulting Unit, John Dedman BuildingCanberraACTAustralia0220
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilRua Borges Lagoa, 564 cj 63São PauloSão PauloBrazil04038‐000
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Fairweather M, Jiang W, Keating NL, Freedman RA, King TA, Nakhlis F. Morbidity of local therapy for locally advanced metastatic breast cancer: an analysis of the Surveillance, Epidemiology, and End Results (SEER)–Medicare Registry. Breast Cancer Res Treat 2018; 169:287-293. [DOI: 10.1007/s10549-018-4689-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/21/2018] [Indexed: 11/24/2022]
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Thery L, Arsene-Henry A, Carroll S, Peurien D, Bazire L, Robilliard M, Fourquet A, Kirova YM. Use of helical tomotherapy in locally advanced and/or metastatic breast cancer for locoregional treatment. Br J Radiol 2018; 91:20170822. [PMID: 29350548 DOI: 10.1259/bjr.20170822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Helical tomotherapy (HT) is a new promising tool whose use remains to be studied. This work assesses its impact for local irradiation in terms of side effects, as well as tumour control in locally advanced (LABC) and metastatic breast cancer (MBC). METHODS We retrospectively reviewed data of 66 patients with LABC and MBC. Patients received standard fractionated radiotherapy by HT, with or without concurrent systemic treatment. RESULTS The median age was 60 years (28-77). The median follow-up of the population was 35.9 months (10.6-95.8). For 91% of patients, HT was concomitant with systemic treatments. Three patients experienced grade 3 skin toxicity and all had concurrent 5FU-vinorelbine. One patient who was receiving concurrent treatment with trastuzumab-pertuzumab had a decreased left ventricular ejection fraction by 14%. No late cardiac or lung toxicity was observed. A clinical benefit was observed in 75% of cases. At 2 months after HT, we observed tumour regression in 7/8 patients, as following: 1 complete, 4 partial responses, and 2 stable disease. The median survival for MBC group was 64.4 months (42.6-65.8) and 21.1 (6.1-36.1) months for LABC. CONCLUSION This study suggests that the use of HT is well tolerated and feasible with a multimodal strategy that includes concurrent systemic treatments for patients with LABC and MBC. Advances in knowledge: The survival of LABC and MBC increases and new safe tools are needed to determine optimal strategies of treatment. To our knowledge, this is the first paper describing the use of HT for this population.
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Beji H, Pilleul F, Picard R, Tredan O, Bouhamama A, Peix M, Mavrovi E, Mastier C. Percutaneous cryoablation of breast tumours in patients with stable metastatic breast cancer: safety, feasibility and efficacy. Br J Radiol 2018; 91:20170500. [PMID: 29243490 DOI: 10.1259/bjr.20170500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate safety, feasibility and efficacy of percutaneous cryoablation of breast tumours in patients with clinically stable metastatic breast cancer, and to compare the findings with reports on alternative procedures, namely surgery and local radiotherapy. METHODS 17 female patients (average age of 54.8 years ± 10.8; range 37-72) with primary breast tumour not surgically treated because of metastatic disease were included. Patients were treated for their primary lesion by percutaneous cryotherapy in period of stable disease. This minimally intervention was performed using ultrasound or CT scan guidance. All patients had clinical and breast-MRI evaluation before and at 1, 3, 6 and 12 months after the procedure. RESULTS All procedures were performed under local anaesthesia and technically successful. The mean largest diameter of the primary lesions was 16 ± 12 mm (size range 5-45 mm). In 15 patients, we obtained a complete regression of the primary breast lesion without recurrence during the follow-up period. Two patients with lesions measured at 40 and 45 mm had recurrence in follow up period. A second session of cryotherapy was performed for these 2 patients, not included in this study. Five patients had painful masses before cryotherapy. All were immediately relieved after the intervention and durably during all follow-up. CONCLUSION These results show that the cryoablation of primary breast lesions seems to be well suited to the palliative care of metastatic patients, particularly because of its good tolerance, low complication rate and ability to provide local or analgesic control. Advances in knowledge: Therapies are limited for these symptomatic patients at metastatic state of primary breast tumour. This study shows that cryoablation in palliative care is achievable in common practice, is effective in local control of the tumour and can provide immediate and long-term analgesic control.
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Affiliation(s)
- Hédi Beji
- 1 Department of Radiologie, Centre Léon Bérard , Lyon , France
| | - Frank Pilleul
- 1 Department of Radiologie, Centre Léon Bérard , Lyon , France
| | - Raphaelle Picard
- 2 Department of Gynécologie, Hôpital Edouard Herriot , Lyon , France
| | - Olivier Tredan
- 3 Department of Oncologie, Centre Léon Bérard , Lyon , France
| | - Amine Bouhamama
- 1 Department of Radiologie, Centre Léon Bérard , Lyon , France
| | - Marie Peix
- 1 Department of Radiologie, Centre Léon Bérard , Lyon , France
| | - Erti Mavrovi
- 4 Department of Radiologie, Hôpital d'instruction des armées Desgenettes , Lyon , France
| | - Charles Mastier
- 1 Department of Radiologie, Centre Léon Bérard , Lyon , France
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Abstract
The impressive advances in breast cancer treatment observed in recent years also apply to the metastatic setting, where a subset of patients with favorable metastatic disease enjoy long-term survival with systemic therapy. In patients with distant disease, the primary tumor in the breast has not classically been though to merit specific locoregional therapy. However, about 6% of Stage IV patients in the USA and up to 20% in limited resource environments present with synchronous distant metastases at the time of initial diagnosis. For this group, who have an intact primary tumor, retrospective studies suggest that local therapy for the primary site may be beneficial. However, these retrospective analyses are biased in that women receiving local therapy to the primary site were younger and had biologically favorable tumors and lower volume metastatic disease. Two completed randomized clinical trials have shown conflicting results, and others are ongoing. In this chapter, we discuss the results of these studies through the present day and summarize their conclusions and their implications for clinical management.
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Wu SG, Zhang WW, He ZY, Sun JY, Chen YX, Guo L. Sites of metastasis and overall survival in esophageal cancer: a population-based study. Cancer Manag Res 2017; 9:781-788. [PMID: 29255373 PMCID: PMC5723120 DOI: 10.2147/cmar.s150350] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background There are few population-based studies of the sites of distant metastasis (DM) and survival from esophageal cancer (EC). The aim of this study was to assess the patterns and survival outcomes for site-specific DM from EC using a population-based approach. Methods Patients diagnosed with de novo stage IV EC between 2010 and 2014 were identified from the Surveillance, Epidemiology, and End Results program database. Overall survival (OS) was compared according to the site of DM. Results We included 3218 patients in this study; the most common site of DM was the liver, followed by distant lymph nodes, lung, bone and brain. Median OS for patients with liver, distant lymph node, lung, bone, and brain metastases was 5, 10, 6, 4, and 6 months, respectively (p<0.001). Site and number of distant metastases were independent prognostic factors for OS. In patients with a single site of DM, using liver metastases as reference, OS was lower for bone metastases (p=0.026) and higher for distant lymph node metastases (p=0.008), while brain (p=0.653) or lung (p=0.081) metastases had similar OS compared with liver metastases. Similar site-specific survival differences were observed in the subgroup with esophageal adenocarcinoma. However, distant lymph node metastases was associated with better survival (p=0.002) compared to liver, bone, or lung metastases in esophageal squamous cell carcinoma. Conclusion Site of metastasis affects survival in metastatic EC; OS was worst for bone metastases and greatest for distant lymph node metastases.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen
| | - Ling Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Wu SG, Zhang WW, Sun JY, Li FY, Lin HX, Zhou J, He ZY. The survival benefits of local surgery in stage IV breast cancer are not affected by breast cancer subtypes: a population-based analysis. Oncotarget 2017; 8:67851-67860. [PMID: 28978078 PMCID: PMC5620218 DOI: 10.18632/oncotarget.18889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/04/2017] [Indexed: 12/31/2022] Open
Abstract
This retrospective study aimed to investigate the clinical value of local surgery in stage IV BC and determined whether the survival outcomes were affected by the breast cancer subtype (BCS). Women with de novo stage IV BC from 2010 to 2013 were included using the Surveillance Epidemiology and End Results database. Univariate and multivariate Cox regression analyses were performed to evaluate the prognostic factors for breast cancer-specific survival (BCSS) and overall survival (OS). Among 9,256 patients were identified, 3,130 (33.8%) were received local surgery. Patients with hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)- subtype were less likely to receive local surgery, while HR-/HER2- tumors were more likely to receive surgery. Multivariate analyses revealed that local surgery improved survival, surgical intervention was an independent favorable prognostic factor for BCSS (P < 0.001) and OS (P < 0.001). Patients who receipt of surgery had better survival outcomes compared with the non-surgery group, and the survival benefits of local surgery were not affected by the BCS status. Local surgery was improved survival for patients with stage IV BC regardless of the BCS status.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People’s Republic of China
| | - Wen-Weng Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
| | - Huan-Xin Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People’s Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People’s Republic of China
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Calaf GM, Roy D. Metastatic genes targeted by an antioxidant in an established radiation- and estrogen-breast cancer model. Int J Oncol 2017; 51:1590-1600. [PMID: 29048630 DOI: 10.3892/ijo.2017.4125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/23/2017] [Indexed: 11/05/2022] Open
Abstract
Breast cancer remains the second most common disease worldwide. Radiotherapy, alone or in combination with chemotherapy, is widely used after surgery as a treatment for cancer with proven therapeutic efficacy manifested by reduced incidence of loco-regional and distant recurrences. However, clinical evidence indicates that relapses occurring after radiotherapy are associated with increased metastatic potential and poor prognosis in the breast. Among the anticarcinogenic and antiproliferative agents, curcumin is a well-known major dietary natural yellow pigment derived from the rhizome of the herb Curcuma longa (Zingiberaceae). The aim of the present study was to analyze the differential expression of metastatic genes in radiation- and estrogen-induced breast cancer cell model and the effect of curcumin on such metastatic genes in breast carcinogenesis. Expression levels of TGF-α and TGFβ1 genes were upregulated in MCF-10F and downregulated in Tumor2 cell lines treated with curcumin. Expression levels of other genes such as caspase 9 and collagen 4 A2 were upregulated in both MCF-10F and Tumor2-treated cell lines. Integrin α5 and cathepsin B and D decreased its expression in Tumor2, whereas E-Cadherin, c-myc and CD44 expressions were only increased in MCF-10F. It can be concluded that metastatic genes can be affected by curcumin in cancer progression and such substance can be used in breast cancer patients with advanced disease without side-effects commonly observed with therapeutic drugs.
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Affiliation(s)
- Gloria M Calaf
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica, Chile
| | - Debasish Roy
- Department of Natural Sciences, Hostos College, The City University of New York, Bronx, NY, USA
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