Metastasis-directed stereotactic radiotherapy in patients with breast cancer: results of an international multicenter cohort study
Year: 2024
Type: article
Study design: Observational Study
Abstract: Metastasis-directed therapy (MDT) for oligometastatic breast cancer (≤ 5 metastases) has shown little effect in specific scenarios of randomized trials. Therefore, we aimed to assess outcomes after metastasis-directed stereotactic radiotherapy (SRT) in various clinical scenarios. We conducted an international retrospective cohort study in thirteen centers including breast cancer patients receiving SRT to any metastatic site. Outcomes included local recurrence (LR), progression-free survival (PFS), and overall survival (OS). Cumulative incidence analysis was used for LR, Kaplan-Meier estimates for PFS and OS. Covariables included patient, disease, and SRT characteristics. We performed univariable and multivariable analyses (MVA). Among 444 patients, 751 metastases were treated with SRT. Of these, 73% were intracranial and 27% extracranial lesions. Oligometastatic disease (OMD) was present in 66% of the patients. LR after two years occurred significantly more often in intracranial (25%) versus extracranial lesions (7%). In MVA of patients with OMD treated for intracranial sites, higher performance status was significantly associated with longer PFS. Further, higher performance status, biologic subtype (HR-pos./HER2-pos.), and MDT to all sites were significantly associated with longer OS. In MVA of oligometastatic patients treated for extracranial sites, biologic subtype (HR-neg./HER2-pos.) and synchronous metastasis were associated with significantly longer PFS, whereas higher grading was associated with significantly shorter PFS. Moreover, biologic subtype (HR-neg./HER2-neg.) was associated with significantly shorter OS. In conclusion, the role of MDT for breast cancer may vary per clinical scenario. Patients with OMD treated for intracranial lesions who had MDT to all sites showed superior OS. Our results should be validated prospectively.
Authors: Alexander Fabian, Daniel Buergy, Fabian Weykamp, Juliane Hörner-Rieber, Denise Bernhardt, Judit Boda-Heggemann, Montserrat Pazos, Nora Mehrhof, David Kaul, Alicia S. Bicu, Eugenia Vlaskou Badra, Susanne Rogers, Stefan Janssen, Hossein Hemmatazad, Katharina Hintelmann, Eleni Gkika, Tim Lange, Konstantinos Ferentinos, Heiko Karle, Thomas Brunner, Andrea Wittig, Marciana Nona-Duma, Oliver Blanck, David Krug
Institutions: University Hospital Schleswig-Holstein, Heidelberg University, University Medical Centre Mannheim, German Cancer Research Center, University Hospital Heidelberg, National Center for Tumor Diseases, Düsseldorf University Hospital, Technical University of Munich, LMU Klinikum, Ludwig-Maximilians-Universität München, Charité - Universitätsmedizin Berlin, HMU Health and Medical University, University of Zurich, University Hospital Zurich, Kantonsspital Aarau, University of Lübeck, University of Bern, University Hospital of Bern, University Medical Center Hamburg-Eppendorf, University of Bonn, University of Freiburg, University Hospital Bonn, University Medical Center Freiburg, Medizinische Hochschule Hannover, European University Cyprus, University Medical Center of the Johannes Gutenberg University Mainz, Graz University Hospital, University of Würzburg, Universitätsklinikum Würzburg, MSH Medical School Hamburg – University of Applied Sciences and Medical University, Helios Hospital Schwerin
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $4,690
OpenAlex ID: W4405655416