Stereotactic Ablative Radiotherapy for Bone-Only Oligometastatic Breast Cancer: On a Quest to Find the Optimum Cohort

IF 3.2 3区医学 Q2 ONCOLOGY Clinical oncology Pub Date : 2024-10-29 DOI:10.1016/j.clon.2024.103670

M.T. Yilmaz, M. Gultekin, S. Yuce Sari, T. Kumru, H. Kivanc, G. Ozyigit, F. Yildiz

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Abstract

Aims

We aimed to evaluate the treatment outcomes and associated prognostic factors in breast cancer (BC) patients who had bone-only oligometastatic disease (OMD) and we tried to determine the subgroup that would benefit most from stereotactic ablative radiotherapy (SABR).

Materials and methods

We enrolled 47 patients with a total of 63 lesions with bone-only oligometastatic BC who underwent SABR for all bone lesions between July 2013 and March 2022. Cases with bone-only metastatic disease with up to 5 metastatic lesions that can be safely treated with SABR were included in this study. All statistical analyses were performed using SPSS 23.0 software (SPSS, Chicago, IL).

Results

The median follow-up time was 34 months. The 2- and 5-year overall survival (OS) rates were 90% and 66%, and the progression-free survival (PFS) rates were 49% and 29%, respectively. The local control rate in the SABR-treated foci was 85%. In multivariate analysis, OMD state (genuine vs. induced), de-novo OMD state (synchronous vs. metachronous), and histology (luminal vs. HER-2 enriched) were prognostic for OS. Molecular subtype switch was observed in 21 (42%) patients, and 0% PFS was observed in 5 years in patients with phenotypic discordance. SABR was well tolerated and there were no ≥grade 4 acute or late toxicities.

Conclusion

Our study showed that in patients with bone-only OMD, in HER2-enriched subtypes with genuine & de-novo & synchronous OMD, SABR should be strongly considered for all metastatic foci, especially if there is phenotypic discordance in the primary tumor and metastasis.

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立体定向消融放疗治疗骨寡转移性乳腺癌：寻找最佳队列。

目的：我们旨在评估纯骨少转移性疾病（OMD）乳腺癌（BC）患者的治疗效果和相关预后因素，并试图确定从立体定向消融放疗（SABR）中获益最多的亚组：2013年7月至2022年3月期间，我们招募了47名患者，共63处骨寡转移性BC病灶，这些患者接受了针对所有骨病灶的SABR治疗。本研究纳入了可通过 SABR 安全治疗的最多 5 个转移病灶的纯骨转移性疾病病例。所有统计分析均使用 SPSS 23.0 软件（SPSS，芝加哥，伊利诺斯州）进行：中位随访时间为 34 个月。2年和5年总生存率（OS）分别为90%和66%，无进展生存率（PFS）分别为49%和29%。SABR治疗病灶的局部控制率为85%。在多变量分析中，OMD状态（真正的与诱发的）、去新OMD状态（同步的与不同步的）和组织学（管腔型与HER-2富集型）是影响OS的预后因素。在 21 例（42%）患者中观察到分子亚型转换，在表型不一致的患者中，5 年的 PFS 为 0%。SABR耐受性良好，没有≥4级的急性或晚期毒性反应：我们的研究表明，在骨OMD患者中，对于HER2富集亚型的真性、去原发和同步OMD患者，应强烈考虑对所有转移灶进行SABR，尤其是在原发肿瘤和转移灶表型不一致的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical oncology 医学-肿瘤学

CiteScore

5.20

自引率

8.80%

发文量

332

审稿时长

40 days

期刊介绍： Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.