Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Prognostic factors in breast cancer with extracranial oligometastases and the appropriate role of radiation therapy

  • Yoo, Gyu Sang (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yu, Jeong Il (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Doo Ho (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2015.07.16
  • Accepted : 2015.10.27
  • Published : 2015.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. Materials and Methods: We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). Results: The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (${\geq}50Gy_{10}$) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (${\leq}1month$) with improved DPFS, and WLRT with improved DPFS and OS, respectively. Conclusion: High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.

Keywords

References

  1. Chia SK, Speers CH, D'yachkova Y, et al. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer 2007;110:973-9. https://doi.org/10.1002/cncr.22867
  2. O'Shaughnessy J. Extending survival with chemotherapy in metastatic breast cancer. Oncologist 2005;10 Suppl 3:20-9. https://doi.org/10.1634/theoncologist.10-90003-20
  3. Sakamoto Y, Yamamoto J, Yoshimoto M, et al. Hepatic resection for metastatic breast cancer: prognostic analysis of 34 patients. World J Surg 2005;29:524-7. https://doi.org/10.1007/s00268-004-7688-6
  4. Pagani O, Senkus E, Wood W, et al. International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured? J Natl Cancer Inst 2010;102:456-63. https://doi.org/10.1093/jnci/djq029
  5. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995;13:8-10. https://doi.org/10.1200/JCO.1995.13.1.8
  6. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of hepatic metastases. Surgery 1988;103:278-88.
  7. Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 1993;218:705-12. https://doi.org/10.1097/00000658-199312000-00002
  8. Corbin KS, Hellman S, Weichselbaum RR. Extracranial oligometastases: a subset of metastases curable with stereotactic radiotherapy. J Clin Oncol 2013;31:1384-90. https://doi.org/10.1200/JCO.2012.45.9651
  9. Friedel G, Pastorino U, Ginsberg RJ, et al. Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases. Eur J Cardiothorac Surg 2002;22:335-44. https://doi.org/10.1016/S1010-7940(02)00331-7
  10. Milano MT, Zhang H, Metcalfe SK, Muhs AG, Okunieff P. Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy. Breast Cancer Res Treat 2009;115:601-8. https://doi.org/10.1007/s10549-008-0157-4
  11. Dellas K. Does radiotherapy have curative potential in metastatic patients? The concept of local therapy in oligometastatic breast cancer. Breast Care (Basel) 2011;6:363-8. https://doi.org/10.1159/000333115
  12. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990;322:494-500. https://doi.org/10.1056/NEJM199002223220802
  13. Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004; 363:1665-72. https://doi.org/10.1016/S0140-6736(04)16250-8
  14. Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 2012;30:419-25. https://doi.org/10.1200/JCO.2011.38.0527
  15. Lee SS, Ahn JH, Kim MK, et al. Brain metastases in breast cancer: prognostic factors and management. Breast Cancer Res Treat 2008;111:523-30. https://doi.org/10.1007/s10549-007-9806-2
  16. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  17. Rusthoven KE, Kavanagh BD, Cardenes H, et al. Multiinstitutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 2009;27:1572-8. https://doi.org/10.1200/JCO.2008.19.6329
  18. Rusthoven KE, Kavanagh BD, Burri SH, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. J Clin Oncol 2009;27:1579-84. https://doi.org/10.1200/JCO.2008.19.6386
  19. Lee MT, Kim JJ, Dinniwell R, et al. Phase I study of individualized stereotactic body radiotherapy of liver metastases. J Clin Oncol 2009;27:1585-91. https://doi.org/10.1200/JCO.2008.20.0600
  20. Kobayashi T, Ichiba T, Sakuyama T, et al. Possible clinical cure of metastatic breast cancer: lessons from our 30-year experience with oligometastatic breast cancer patients and literature review. Breast Cancer 2012;19:218-37. https://doi.org/10.1007/s12282-012-0347-0
  21. Rauschecker H, Clarke M, Gatzemeier W, Recht A. Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev 2001;(4):CD002195.
  22. Chiang AC, Massague J. Molecular basis of metastasis. N Engl J Med 2008;359:2814-23. https://doi.org/10.1056/NEJMra0805239
  23. Kang Y, Siegel PM, Shu W, et al. A multigenic program mediating breast cancer metastasis to bone. Cancer Cell 2003;3:537-49. https://doi.org/10.1016/S1535-6108(03)00132-6
  24. Minn AJ, Gupta GP, Siegel PM, et al. Genes that mediate breast cancer metastasis to lung. Nature 2005;436:518-24. https://doi.org/10.1038/nature03799
  25. Tanaka F, Li M, Hanaoka N, et al. Surgery for pulmonary nodules in breast cancer patients. Ann Thorac Surg 2005;79:1711-4. https://doi.org/10.1016/j.athoracsur.2004.10.033
  26. Pocard M, Pouillart P, Asselain B, Salmon R. Hepatic resection in metastatic breast cancer: results and prognostic factors. Eur J Surg Oncol 2000;26:155-9. https://doi.org/10.1053/ejso.1999.0761
  27. Rena O, Papalia E, Ruffini E, et al. The role of surgery in the management of solitary pulmonary nodule in breast cancer patients. Eur J Surg Oncol 2007;33:546-50. https://doi.org/10.1016/j.ejso.2006.12.015
  28. Vlastos G, Smith DL, Singletary SE, et al. Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic metastases. Ann Surg Oncol 2004;11:869-74. https://doi.org/10.1245/ASO.2004.01.007
  29. Largillier R, Ferrero JM, Doyen J, et al. Prognostic factors in 1,038 women with metastatic breast cancer. Ann Oncol 2008;19:2012-9. https://doi.org/10.1093/annonc/mdn424
  30. Ahn SG, Lee HM, Cho SH, et al. Prognostic factors for patients with bone-only metastasis in breast cancer. Yonsei Med J 2013;54:1168-77. https://doi.org/10.3349/ymj.2013.54.5.1168
  31. Domchek SM, Younger J, Finkelstein DM, Seiden MV. Predictors of skeletal complications in patients with metastatic breast carcinoma. Cancer 2000;89:363-8. https://doi.org/10.1002/1097-0142(20000715)89:2<363::AID-CNCR22>3.0.CO;2-3
  32. Koizumi M, Yoshimoto M, Kasumi F, Ogata E. Comparison between solitary and multiple skeletal metastatic lesions of breast cancer patients. Ann Oncol 2003;14:1234-40. https://doi.org/10.1093/annonc/mdg348
  33. Murabito M, Salat A, Mueller MR. Complete resection of isolated lung metastasis from breast carcinoma results in a strong increase in survival. Minerva Chir 2000;55:121-7.

Cited by

  1. Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis vol.22, pp.30, 2016, https://doi.org/10.3748/wjg.v22.i30.6851
  2. Spine Metastasis Practice Patterns among Korean, Chinese, and Japanese Radiation Oncologists: A Multinational Online Survey Study vol.58, pp.1, 2015, https://doi.org/10.1093/jrr/rrw089
  3. Survival outcomes following aggressive treatment of oligometastatic breast cancer: a systematic review protocol vol.15, pp.8, 2015, https://doi.org/10.11124/jbisrir-2016-002954
  4. Oligometastases in Genitourinary Tumors: Recent Insights and Future Molecular Diagnostic Approach vol.16, pp.12, 2017, https://doi.org/10.1016/j.eursup.2017.09.005
  5. A risk‐based approach to identifying oligometastatic disease on imaging vol.144, pp.3, 2015, https://doi.org/10.1002/ijc.31793
  6. Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases vol.119, pp.4, 2019, https://doi.org/10.1002/jso.25361
  7. Oligometastatic breast cancer vol.26, pp.2, 2015, https://doi.org/10.1007/s12282-018-0921-1
  8. Extracranial Stereotactic Body Radiotherapy in Oligometastatic or Oligoprogressive Breast Cancer vol.10, pp.None, 2015, https://doi.org/10.3389/fonc.2020.00987
  9. Management of oligometastatic and oligoprogressive renal cell carcinoma: state of the art and future directions vol.20, pp.6, 2015, https://doi.org/10.1080/14737140.2020.1770601
  10. Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians vol.12, pp.9, 2015, https://doi.org/10.3390/cancers12092390
  11. Prognostic factors in patients with oligometastatic breast cancer – A systematic review vol.91, pp.None, 2020, https://doi.org/10.1016/j.ctrv.2020.102114
  12. Clinical features and prognostic factors for extracranial oligometastatic breast cancer in China vol.147, pp.11, 2015, https://doi.org/10.1002/ijc.33152
  13. Stereotactic body radiotherapy to treat breast cancer oligometastases: A systematic review with meta-analysis vol.164, pp.None, 2015, https://doi.org/10.1016/j.radonc.2021.09.031