Copyright
©The Author(s) 2022.
World J Clin Oncol. Jan 24, 2022; 13(1): 39-48
Published online Jan 24, 2022. doi: 10.5306/wjco.v13.i1.39
Published online Jan 24, 2022. doi: 10.5306/wjco.v13.i1.39
Table 1 Prospective randomized phase III trials investigating the role of locoregional treatment in de novo metastatic breast cancer
Ref. | n | Treatment | Patients | Median follow-up (mo) | Outcomes |
Khan et al[21] (ECOG-ACRIN E2108) | 256 | Primary systemic therapy: LRT (n = 125); No LRT (n = 131) | NR | 59 | 3-yr OS: 68.4% vs 67.9%, P = 0.63 |
3-yr locoregional recurrence/progression: 10.2% vs 25.6%, P = 0.003 | |||||
Fitzal et al[18] (ABCSG-28 POSYTIVE) | 90 | Arm A: Primary surgery + systemic therapy (n = 45) | Arm A: More cT3 and cN2 tumors | 37.5 | Stopped early |
Median OS (mo): 34.6 vs 54.8, P = 0.267 | |||||
Time to distant progression (mo): 13.9 vs 29.0, P = 0.0668 | |||||
Arm B: Primary systemic therapy (n = 45) | |||||
Soran et al[20] (MF07-01) | 274 | LRT + systemic therapy (n = 138) | LRT arm: More ER/PR (+), less triple negative tumors | 54.5 vs 55 | Median OS (mo): 46 vs 37, P = 0.005 |
Systemic therapy (n = 136) | Unplanned subgroup analysis: Improvement in survival: ER/PR (+), HER2 (-), < 55 yr, solitary bone-only metastasis | ||||
Badwe et al[19] (NCT00193778) | 350 | Primary systemic therapy: LRT (n = 173); No LRT (n = 177) | Similar patient and tumor characteristics | 23 | Median OS (mo): 19.2 vs 20.5, P = 0.79 |
Median LR-PFS (mo): not attained vs 18.2, P < 0.0001 | |||||
Median distant-PFS (mo): 11.3 vs 19.8, P = 0.012 |
Table 2 Retrospective studies published within the last decade investigating the impact of locoregional treatment to the primary tumor site in de novo metastatic breast cancer
Ref. | n | Treatment | Patient | Median follow-up (mo) | Outcomes |
Ma et al[35] | 987 | Surgery (n = 463) | Surgery arm: More T1-2, HR-positive, solitary metastasis, bone only metastasis | NR | Median survival (mo): 45 vs 28, P < 0.001 |
No surgery (n = 524) | |||||
Better survival in surgery after systemic therapy than primary surgery | |||||
Triple negative, brain metastases: No benefit of surgery | |||||
Lane et al[16] (NCDB) | 24015 | Systemic therapy alone (n = 13505) | Surgery after systemic therapy arm: Younger, more T3-4 and HR-negative | NR | Median OS (mo): 37.5 vs 49.4 vs 52.8, P < 0.001 |
Surgery before systemic therapy (n = 4552) | RT: No impact on OS | ||||
Systemic therapy before surgery (n = 5958) | |||||
Li et al[36] (SEER database) | 20870 | Surgery (n = 5779) | Surgery arm: Younger, more T1-3, N+, Gr III, and less HR+ | NR | Surgery arm (± RT): Improved BCSS and OS (P < 0.001) |
No surgery (n = 15091) | |||||
More chemo and RT received | |||||
Pons-Tostivint et al[37] | 4276 | LRT (n = 1706): Surgery, RT or both | LRT arm: Younger, more solitary or bone-only metastases | 45.3 | Median OS (mo): HR-positive, HER2- negative: 61.6 vs 45.9, P < 0.001 |
No LRT (n = 2570) | HR-positive, HER2-positive: 77.2 vs 52.6, P = 0.008 | ||||
Triple negative: 19 vs 18.6, P = 0.54 | |||||
Bone only metastases: 70.4 vs 62, P < 0.001 | |||||
Visceral metastases: 83 vs 52.7, P < 0.001 | |||||
Choi et al[38] | 245 | LRT (n = 82): Surgery, RT or both | LRT arm: < T4, no liver or brain metastasis, and < 5 metastatic sites | 40 | 5-yr LRFS: 62% vs 20%, P < 0.001 |
5-yr OS:73% vs 45%, P = 0.02 | |||||
No LRT (n = 163) | |||||
Gultekin et al[7] | 227 | LRT (n = 188): Surgery, RT or both | LRT arm: Less T3-4 and more solitary metastases | 35 | 5-yr OS: 56% vs 24%, P < 0.001 |
5-yr PFS: 27% vs 7%, P < 0.0001 | |||||
No LRT (n = 39) | |||||
Nguyen et al[39] | 733 | LRT (n = 378): Surgery, RT or both | LRT arm: Younger, more T1-2, N0-1, limited M1 disease | 21 | 5-yr OS: 21% vs 14%, P < 0.001 |
5-yr PFS 72% vs 46%, P < 0.001 | |||||
No LRT (n = 355) | |||||
Neuman et al[25] | 186 | Surgery (n = 69): 13% RT | Surgery arm: More HER2-negative, smaller tumors, more solitary metastasis | 52 | No difference in OS (P = 0.10) |
No surgery (n = 117) |
Table 3 Retrospective studies investigating the role of radiotherapy as a local treatment of metastases in oligometastatic disease
Ref. | n | Treatment | Patients | Median follow-up (mo) | Outcomes |
Weykamp et al[28] | 46 | SBRT: Bone, lung, liver, adrenal gland | Inclusion criteria: breast cancer, oligometastatic (≤ 3) or oligoprogressive (1) disease | 21 | 2-yr LC, DC, PFS and OS: 89%, 44%, 17%, and 62%, respectively |
Median 3 frx (1-10)/28 Gy (24-60 Gy) | |||||
Solitary metastasis: Poor prognostic factor for DC and PFS | |||||
58 lesions | |||||
Higher age: Poor prognostic factor for OS | |||||
Kobayashi et al[29] | 75 | Primary systemic chemotherapy: CR/PR | Inclusion criteria: breast cancer, ≤ 2 metastatic organs, < 5 metastases, < 5 cm lesions | 103 | 10-yr and 20-yr OS: 59.2% and 34.1%, respectively |
Surgery or RT | 10-yr and 20-yr RFS: 27.4% | ||||
Single organ metastasis, local treatment and shorter DFI: Better RFS | |||||
Hong et al[4] | 361 | SBRT | Extracranial oligometastases (≤ 5) | 26.2 | 3-yr OS, PFS and TMC were 56%, 24%, and 72%, respectively |
10 frx/50-60 Gy or 3 frx/24-48 Gy | |||||
Breast cancer (16%) | |||||
Primary tumor type, interval to metastasis, number of treated metastasis, and mediastinal/hilar LN, liver, or adrenal metastases: Associated with OS | |||||
All breast cancer patients: RPA class 1 (3-yr OS 75%) | |||||
Cha et al[40] | 49 | Endocrine therapy plus LRT (n = 33) | Inclusion criteria: HR-positive, HER2-negative | 101.6 vs 105.6 | Median OS (mo): 72.3 vs 91, P = 0.272 |
82% RT: Bone, LN | |||||
Endocrine therapy alone (n = 16) | |||||
Median PFS (mo): 30 vs 18, P = 0.049 | |||||
Similar patient and tumor characteristics |
Table 4 Prospective studies exploring the role of radiotherapy to metastatic sites in oligometastatic disease including primary breast cancer
Ref. | n | Treatment | Patients | Median follow-up (mo) | Outcomes |
Palma et al[5] (SABR-COMET) | 99 | Palliative RT ± systemic therapy (n = 33) | Inclusion criteria: 1-5 metastases, life expectancy ≥ 6 mo, controlled primary tumor | 51 | 5-yr OS: 17.7% vs 42.3%, P = 0.006 |
4-yr PFS 3.2% vs 21.6%, P = 0.001 | |||||
1 frx/8 Gy or 10 frx/30 Gy | |||||
LC 46% vs 63%, P = 0.039 | |||||
SABR ± systemic therapy (n = 66) | |||||
≥ Gr 2 toxicity: 9% vs 29%, P = 0.026 | |||||
Primary breast cancer (n): 5 vs 13 | |||||
Different regimens according to tumor size and location | SABR: Gr 5 toxicity (n = 3) | ||||
Milano et al[9] | 48 | HSRT: ≥ 50 Gy in 10 frx | Inclusion criteria: breast cancer, 1-5 extracranial metastases, primary controlled | 52 | 5- and 10-yr OS: |
Bone-only oligometastases: 83% and 75% | |||||
Non-bone-only oligometastases: 31% and 17% (P = 0.002) | |||||
GTV > 25 cc: Poor prognostic factor for LC | |||||
Trovo et al[6] | 54 | SBRT: 3 frx/30-45 Gy (n = 44) | Inclusion criteria: breast cancer, ≤ 5 extracranial metastases, primary controlled | 30 | 2-y LC: 97% |
2-y OS: 95% | |||||
IMRT: 25 frx/60 Gy (n = 10) | 1- and 2-yr PFS: 75% and 53%, respectively | ||||
No ≥ Gr 3 toxicity | |||||
92 lesions | |||||
Salama et al[26] | 61 | SBRT: Lung, LN, liver, bone, adrenal, soft tissue, pancreas | Inclusion criteria: 1-5 metastatic sites, life expectancy > 3 mo | 20.9 | 1-yr and 2-yr OS: 81.5% and 56.7%, respectively |
1-yr and 2-yr PFS: 33.3% and 22.0%, respectively | |||||
3 frx/24-48 Gy | Breast cancer (11.3%) | ||||
Scorsetti et al[31] | 33 | SBRT: 3-4 frx/48-75 Gy | Inclusion criteria: breast cancer, < 5 lung or liver metastases, other metastatic sites stable or responding after chemotherapy | 24 | 1- and 2-yr LC: 98% and 90%, respectively |
1- and 2-yr OS: 93% and 66%, respectively | |||||
1- and 2-yr PFS: 48% and 27%, respectively | |||||
No grade 3-4 toxicities | |||||
43 lesions | |||||
Milano et al[30] | 40 | SBRT doses and fractionation was not mentioned | Inclusion criteria: breast cancer, ≤ 5 metastases | NR | 4-yr OS: 59% |
4-yr PFS: 38% | |||||
4-yr LC: 89% | |||||
Favorable prognosis: Solitary metastasis, smaller tumor volume, bone-only disease, and stable or regressing lesions |
- Citation: Beduk Esen CS, Gultekin M, Yildiz F. Role of radiotherapy in oligometastatic breast cancer: Review of the literature. World J Clin Oncol 2022; 13(1): 39-48
- URL: https://www.wjgnet.com/2218-4333/full/v13/i1/39.htm
- DOI: https://dx.doi.org/10.5306/wjco.v13.i1.39