Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-25T09:55:04.262Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of loco-regional treatment including radiotherapy in patients presenting with metastatic breast cancer

Published online by Cambridge University Press:  10 May 2021

Budhi Singh Yadav Open the ORCID record for Budhi Singh Yadav [Opens in a new window] ,
Rubu Sunku  and
Divya Dahiya Open the ORCID record for Divya Dahiya [Opens in a new window]
Budhi Singh Yadav*
Affiliation:
Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Rubu Sunku
Affiliation:
Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Divya Dahiya
Affiliation:
General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
*
Author for correspondence: Dr Budhi Singh Yadav, Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh 91160012, India. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

chemotherapyloco-regional treatmentmetastatic breast cancerradiotherapysurgery
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 4 , December 2022 , pp. 466 - 471
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agarwal, G, Ramakant, P. Breast cancer care in India: the current scenario and the challenges for the future. Breast Care 2008; 3: 21–27.CrossRefGoogle ScholarPubMed
Neuman, H B, Morrogh, M, Gonen, M et al. Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer 2010; 116: e1226–e1233.CrossRefGoogle ScholarPubMed
Hong Ly, B, Vlastos, G, Rapiti, E, Vinh-Hung, V, Nguyen, N P. Local-regional radiotherapy and surgery is associated with a significant survival advantage in metastatic breast cancer patients. Tumori 2010; 96: 947–954.Google Scholar
Nguyen, D H A, Truong, P T, Alexander, C et al. Can locoregional treatment of the primary tumor improve outcomes for women with stage IV breast cancer at diagnosis? Int J Radiat Oncol Biol Phys 2012; 84: 39–45.CrossRefGoogle ScholarPubMed
Khan, S A, Stewart, A K, Morrow, M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 2002; 132: 620–632.CrossRefGoogle ScholarPubMed
Pons-Tostivint, E, Kirova, Y, Lusque, A et al. 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 2019; 26: 356–365.CrossRefGoogle Scholar
Mauro, G P, de Andrade Carvalho, H, Stuart, S R, Mano, M S, Marta, G N. Effects of locoregional radiotherapy in patients with metastatic breast cancer. Breast 2016; 28: 73–78.CrossRefGoogle ScholarPubMed
Pons-Tostivint, E, Kirova, Y, Lusque, A et al. Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis. Radioth Oncol 2020; 145: 109–116.CrossRefGoogle Scholar
Amin, M B, Edge, S, Greene, F et al. (eds.). AJCC Cancer Staging Manual, 8th edition. Springer. CrossRefGoogle Scholar
Cox, J D, Stetz, J, Pajak, T F. Toxicity criteria of the radiation therapy oncology group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31 (5): 1341–1346.CrossRefGoogle Scholar
Rapiti, E, Verkooijen, H M, Vlastos, G et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 2006; 24: 2743–2749.CrossRefGoogle ScholarPubMed
Le Scodan, R, Stevens, D, Brain, E et al. Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. JCO 2009; 27: 1375–1381.CrossRefGoogle ScholarPubMed
Bourgier, C, Khodari, W, Vataire, A- L et al. Breast radiotherapy as part of loco-regional treatments in stage IV breast cancer patients with oligometastatic disease. Radiother Oncol 2010; 96: 199–203.CrossRefGoogle ScholarPubMed
Chia, S K, Speers, C H, 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: 973–979.CrossRefGoogle Scholar
Gnerlich, J, Jeffe, D B, Deshpande, A D et al. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER Data. Ann Surg Oncol 2007; 14: 2187–2194.CrossRefGoogle ScholarPubMed
Hazard, H W, Gorla, S R, Scholtens, D et al. Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer 2008; 113: e2011–e2019.CrossRefGoogle ScholarPubMed
Badwe, R, Parmar, V, Hawaldar, R et al. Surgical removal of primary tumor and axillary lymph nodes in women metastatic breast cancer at first presentation: a randomized controlled trial. 2013 San Antonio Breast Cancer Symposium. San Antonio, Texas, 2013.Google Scholar
Soran, A, Ozbas, S, Kelsey, S F, Gulluoglu, B M. Randomized trial comparing locoregional resection of primary tumor with no surgery in stage IV breast cancer at the presentation (Protocol MF07–01): a study of Turkish Federation of the National Societies for Breast Diseases. Ann Surg Oncol 2018; 25 (11): 3141–3149.CrossRefGoogle Scholar
Local Surgery for Metastatic Breast Cancer - Full Text View. ClinicalTrials.govNCT01242800. Accessed on 24th January 2021.Google Scholar
Primary Operation in SYnchronous meTastasized InVasivE Breast Cancer (POSYTIVE). ClinicalTrials.govNCT01015625. Accessed on 24th January 2021.Google Scholar