Impact of loco-regional treatment on metastatic breast cancer outcome: A review

Khodari, W.; Sedrati, A.; Naisse, I.; Bosc, Romain; Belkacémi, Yazid

doi:10.1016/j.critrevonc.2012.12.005

Cited by 21 publications

(15 citation statements)

References 61 publications

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“…Although better OS was seen in the group of patients treated with BCS compared to those treated with a mastectomy, the absence of a difference in local control when analyzing the same variable suggests a selection bias favoring BCS for the most favorable patients. Although the effect of local regional treatment on overall survival in the metastatic setting is a matter of active discussion [ 26 - 28 ] with some retrospective data suggesting a benefit [ 29 - 31 ], two randomized controlled trials recently presented showed no improvement in survival for patients undergoing loco-regional treatment (SABCS 2013;Badwe R: Abstract S2–02, Soran, A: Abstract S2-03). The primary goal of any loco-regional treatment is to avoid local progression and reduce disease burden and through local control, improve the quality of life of patients even when no survival benefit has been proven yet.…”

Section: Discussionmentioning

confidence: 99%

Re-irradiation for locally recurrent refractory breast cancer

2015

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PurposeTo report an analysis of treatment outcomes of a cohort of patients re-irradiated for locally recurrent refractory breast cancer (LRRBC)Patients and MethodsBetween 2008 and 2013, 47 women (mean age = 60 years) were re-irradiated for LRRBC. Outcomes were measured using Kaplan-Meier log rank to compare curves and Cox regression for multivariate analysis. Outcomes included overall survival (OS), time to re-treatment, survival without systemic progression, and survival without local recurrence.ResultsFifty-six instances of re-irradiation were completed and analyzed. The mean cumulative 2 Gy equivalent dose (EQD2) to the whole breast and tumour cavity (α/β = 3) was 99.8 Gy and 109.1 Gy, respectively. Most patients initially had significant symptoms before RT due to local recurrence. The median time to re-treatment and to systemic failure was 41 and 50 months, respectively. Median follow-up for OS was 17 months and OS was 0.73 (SE = 0.07) at 1 year and 0.67 (SE = 0.07) at 2 years. Local control was 0.62 (SE = 0.07) and 0.5 (0.08) at 1 and 2 years, respectively. Acute radiation dermatitis was G1-2, G3 and G4 in 45, 4 and 1 cases, respectively. One patient presented with necrosis. The most common long term toxicity was G3 fibrosis (n = 4) and telangiectatic changes (n = 3). Multivariable analysis indicated that skin involvement (Hazard Ratio = 6.6 (1.4-31), p = 0.016) and time to local recurrence <2yr (HR 3.1 (1.04-9.7) p = 0.042) predicted local recurrence.ConclusionHigh dose re-irradiation is feasible for locally RRBC. This approach can have a significant benefit in this very high-risk group.

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Section: Discussionmentioning

confidence: 99%

Re-irradiation for locally recurrent refractory breast cancer

2015

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“…Median survival rates range from one to four years, but on an individual level, survival times of up to 15 years have been reported [8], [9], [10], [11], [12], [13], [14], [15]. While recent studies suggest that surgical removal of primary breast tumor has a positive impact on the survival of de novo metastatic patients [16], [17], [18], systemic therapy, is the main treatment.…”

Section: Introductionmentioning

confidence: 99%

Predicting Survival of De Novo Metastatic Breast Cancer in Asian Women: Systematic Review and Validation Study

et al. 2014

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BackgroundIn Asia, up to 25% of breast cancer patients present with distant metastases at diagnosis. Given the heterogeneous survival probabilities of de novo metastatic breast cancer, individual outcome prediction is challenging. The aim of the study is to identify existing prognostic models for patients with de novo metastatic breast cancer and validate them in Asia.Materials and MethodsWe performed a systematic review to identify prediction models for metastatic breast cancer. Models were validated in 642 women with de novo metastatic breast cancer registered between 2000 and 2010 in the Singapore Malaysia Hospital Based Breast Cancer Registry. Survival curves for low, intermediate and high-risk groups according to each prognostic score were compared by log-rank test and discrimination of the models was assessed by concordance statistic (C-statistic).ResultsWe identified 16 prediction models, seven of which were for patients with brain metastases only. Performance status, estrogen receptor status, metastatic site(s) and disease-free interval were the most common predictors. We were able to validate nine prediction models. The capacity of the models to discriminate between poor and good survivors varied from poor to fair with C-statistics ranging from 0.50 (95% CI, 0.48–0.53) to 0.63 (95% CI, 0.60–0.66).ConclusionThe discriminatory performance of existing prediction models for de novo metastatic breast cancer in Asia is modest. Development of an Asian-specific prediction model is needed to improve prognostication and guide decision making.

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“…Several retrospective studies have been cited on the suggested strong association between locoregional therapy and improvement of metastatic progression-free survival and overall survival (Khodari et al 2013 ). However, there is few data to better define subgroups of patients who would benefit from locoregional therapy, and thus the wide variability in treatment choice always exists.…”

Section: Introductionmentioning

confidence: 99%

Locoregional therapy in luminal-like and HER2-enriched patients with de novo stage IV breast cancer

et al. 2013

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BackgroundLocoregional therapy is rarely the standard of care for De Novo stage IV breast cancer but usually used for palliation of symptoms. This retrospective study aimed to determine whether surgery or radiation would contribute to survival benefit for this group of patients by examining the survival outcome through the disease molecular subtypes.Materials and methodsWe reviewed 246 patients with de novo stage IV (M1) breast cancer treated at our hospital between 1990 and 2009. Multivariable Cox Analysis was used to evaluate the survival association with subtypes and clinicopathologic factors.ResultsPatients with luminal-like subtype are mostly premonopausal (66.9%, P = 0.0002), with abnormal CA 15–3 level at initial diagnosis (58.7%, P = 0.01), a higher rate of bony metastases (78.5%, P = 0.02), and a lower rate of liver metastases (22.3%, P < 0.0001). Patients with HER2-enriched and triple negative showed higher rate of nuclear grade III, up to 35% and 40%, respectively (P = 0.01). There is no difference in treatment options patient received: systemic chemotherapy up to 82.2 ~ 95% (p = 0.0705), locoregional treatment up to 40.0 ~ 51.2% (P-0.2571). The median overall survival was 23.1 months: luminal-like subtype 39.6 months, HER2-enriched subtype 17.9 months, and triple negative subtype 13.3 months, respectively (P < 0.0001). In multivariate analysis, poor prognostic factors included HER2-enriched (HR 2.2, P < 0.0001) and triple negative subtype (HR 4.3, P < 0.0001), liver metastasis (HR 1.9, P < 0.0001), lung metastasis (HR 1.4, P = 0.0153), and bone metastasis (HR 1.8, P = 0.0007). Subgroup analysis revealed that local treatments (surgery or radiotherapy) to primary/regional tumors achieved better survival in patients with luminal-like (3-year survival 66.4% vs. 34.4%, p = 0.0001) and HER2-enriched (3-year survival 41.6% vs. 8.8%, p = 0.0012) subtypes, but not in triple negative subtype (P = 0.9575).ConclusionsFor better survival outcome, De Novo Stage IV breast cancer patients with luminal-like or HER2-enriched subtype should be offered local treatments when surgery and/or radiotherapy presents an option for proper control of the primary and regional tumors.

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Impact of loco-regional treatment on metastatic breast cancer outcome: A review

Cited by 21 publications

References 61 publications

Re-irradiation for locally recurrent refractory breast cancer

Re-irradiation for locally recurrent refractory breast cancer

Predicting Survival of De Novo Metastatic Breast Cancer in Asian Women: Systematic Review and Validation Study

Locoregional therapy in luminal-like and HER2-enriched patients with de novo stage IV breast cancer

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