Filippo Merloni, Michela Palleschi, Caterina Gianni, Marianna Sirico, Riccardo Serra, Chiara Casadei, Samanta Sarti, Lorenzo Cecconetto, Giandomenico Di Menna, Marita Mariotti, Roberta Maltoni, Daniela Montanari, Antonino Romeo, Ugo De Giorgi
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引用次数: 0
摘要
转移性乳腺癌(MBC)仍然是一种无法治愈的疾病,它最终会对全身治疗产生抗药性。虽然大多数患者在接受全身治疗(ST)期间会出现广泛的疾病进展,但在某些情况下,进展可能发生在少数转移部位。来自其他恶性肿瘤的证据表明,对少进展性疾病(OPD)采用立体定向消融放疗(SABR)进行局部治疗可有效控制疾病,而无需改变全身治疗方案。有关少进展期乳腺癌局部治疗的现有证据很有限,大多是回顾性研究。唯一的随机数据来自随机CURB试验,该试验招募了少进展性疾病患者,包括小细胞肺癌和乳腺癌患者,结果显示局部治疗对后一组患者的生存并无益处。然而,临床实践中仍考虑对少进展 MBC 进行局部治疗,尤其是为了推迟转用毒性更强的 STs。本综述旨在根据现有知识确定可能从这种方法中获益的患者,同时关注与放疗(RT)和ST联合治疗相关的潜在风险以及未来可能出现的情况。
Local treatment for oligoprogressive metastatic sites of breast cancer: efficacy, toxicities and future perspectives.
Metastatic breast cancer (MBC) is still an incurable disease, which eventually develops resistance mechanisms against systemic therapies. While most patients experience widespread disease progression during systemic treatment (ST), in some cases, progression may occur at a limited number of metastatic sites. Evidence from other malignancies suggests that local treatment with stereotactic ablative radiotherapy (SABR) of oligoprogressive disease (OPD) may allow effective disease control without the need to modify ST. Available evidence regarding local treatment of oligoprogressive breast cancer is limited, mostly consisting of retrospective studies. The only randomized data come from the randomized CURB trial, which enrolled patients with oligoprogressive disease, including both small cell lung cancer and breast cancer patients, and did not show a survival benefit from local treatment in the latter group. However, local treatment of oligoprogressive MBC is still considered in clinical practice, especially to delay the switch to more toxic STs. This review aims to identify patients who may benefit from this approach based on the current available knowledge, focusing also on the potential risks associated with the combination of radiotherapy (RT) and ST, as well as on possible future scenarios.
期刊介绍:
The Journal''s scope encompasses all aspects of metastasis research, whether laboratory-based, experimental or clinical and therapeutic. It covers such areas as molecular biology, pharmacology, tumor biology, and clinical cancer treatment (with all its subdivisions of surgery, chemotherapy and radio-therapy as well as pathology and epidemiology) insofar as these disciplines are concerned with the Journal''s core subject of metastasis formation, prevention and treatment.