Influence of radiotherapy intervention on local control of oligometastatic breast cancer

doi:10.3877/cma.j.issn.1674-0807.2023.02.002

Abstract

Abstract:

Objective

To investigate the effect of radiotherapy on the local control of oligometastatic breast cancer.

Methods

A retrospective analysis was performed on the clinical records of 75 patients with oligometastatic breast cancer after surgery in the Weihai Municipal Hospital, Shandong University from January 1, 2013 to June 30, 2017. All patients underwent intensity modulated radiotherapy or 3D conformal radiotherapy on oligometastatic sites. The Kaplan-Meier method was used for survival analysis and the log-rank test was used for group comparison. χ² test or Fisher exact text was used to compare clinicopathologic features between the whole lesion radiotherapy group and the non-whole lesion radiotherapy group. The Cox regression was used for multivariate analysis.

Results

Intensity modulated radiotherapy was used in 68 cases and 3D conformal radiotherapy was used in 7 cases. The radiation sites were listed as follow: bone in 30 cases, lung in 22 cases, lymph nodes in 19 cases, brain in 3 cases and liver in one case. The median follow-up was 42.0 months (range: 32.0-52.0 months). The 5-year OS, progression-free survival (PFS) and local control rate (LC) was 65.4%, 68.6% and 64.4%, respectively. Totally 50 cases received the whole lesion radiotherapy and other 25 cases received non-whole lesion radiotherapy. The prognosis of patients in the whole lesion radiotherapy group was significantly better than that in the non-whole lesion radiotherapy group (5-year PFS: 88.9% vs 22.0%, χ²=17.381, P<0.001; 5-year OS: 82.5% vs 22.7%, χ²=15.416, P<0.001; 5-year LC: 87.3% vs 24.0%, χ²=15.669, P<0.001). There were no significant differences in the 5-year LC, OS and PFS between patients receiving radiotherapy on different sites. Multivariate analysis showed that whole lesion radiotherapy and histological grade 2 were independent protective factors for LC (HR=0.115, 95%CI: 0.037-0.363, P<0.001; HR=0.138, 95%CI: 0.029-0.651, P=0.012), PFS(HR=0.127, 95%CI: 0.041-0.392, P<0.001; HR=0.150, 95%CI: 0.034-0.661, P=0.012)and OS(HR=0.144, 95%CI: 0.047-0.441, P=0.001; HR=0.169, 95%CI: 0.038-0.754, P=0.020); tumor diameter<3 cm was an independent protective factor for LC (HR=0.265, 95%CI: 0.092-0.764, P=0.014).

Conclusion

The whole lesion radiotherapy can improve the prognosis of oligometastatic breast cancer and it can increase LC, especially for patients with tumor of histological grade 2 or the diameter <3 cm.

Key words: Breast neoplasms, Radiotherapy, Oligometastasis, Local control rate

Shuwei Wang, Jinjun Yin, Jiangchao Shao, Qiumei Cong, Bing Wang. Influence of radiotherapy intervention on local control of oligometastatic breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(02): 72-79.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhrxbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0807.2023.02.002

https://zhrxbzz.cma-cmc.com.cn/EN/Y2023/V17/I02/72

Figures/Tables 7

References 20

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021，71(3)：209-249.
[2]	Xu B, Yan M, Ma F, et al. Pyrotinib plus capecitabine versus lapatinib plus capecitabine for the treatment of HER2-positive metastatic breast cancer (PHOEBE): a multicentre, open-label, randomised, controlled, phase 3 trial[J]. Lancet Oncol, 2021, 22(3)：351-360.
[3]	Saura C, Oliveira M, Feng YH, et al. Neratinib plus capecitabine versus lapatinib plus capecitabine in HER2-positive metastatic breast cancer previously treated with≥2 HER2-directed regimens: phase III NALA trial[J]. J Clin Oncol, 2020, 38(27)：3138-3149.
[4]	Murthy RK, Loi S, Okines A, et al. Tucatinib, trastuzumab, and capecitabine for HER2-positive metastatic breast cancer[J]. N Engl J Med, 2020, 382(7)：597-609.
[5]	Modi S, Saura C, Yamashita T, et al. Trastuzumab deruxtecan in previously treated HER2-positive breast cancer[J]. N Engl J Med, 2020, 382(7)：610-621.
[6]	Schmid P, Rugo HS, Adams S, et al. Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable, locally advanced or metastatic triple-negative breast cancer (IMpassion130): updated efficacy results from a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet Oncol, 2020, 21(1)：44-59.
[7]	Hellman S, Weichselbaum RR. Oligometastases[J]. J Clin Oncol, 1995, 13(1)：8-10.
[8]	Cardoso F, Costa A, Senkus E, et al. 3rd ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 3)[J]. Breast, 2017, 31：244-259.
[9]	Yoo GS, Yu JI, Park W, et al. Prognostic factors in breast cancer with extracranial oligometastases and the appropriate role of radiation therapy[J]. Radiat Oncol J, 2015, 33(4)：301-309.
[10]	宋玉春，房辉，王淑莲，等. 85例颅外转移性乳腺癌放射治疗疗效观察及预后分析[J]．中华放射肿瘤学杂志，2021, 30(6)：569-574.
[11]	Guckenberger M, Lievens Y, Bouma AB, et al. Characterization and classification of oligometastatic disease: an European Society for Radiotherapy and Oncology and European Organization for Research and Treatment of Cancer consensus recommendation [J]. Lancet Oncol, 2020, 21(1)：e18-e28.
[12]	Milano MT, Katz AW, Zhang H, et al. Oligometastases treated with stereotactic body radiotherapy: long-term follow-up of prospective study[J]. Int J Radiat Oncol Biol Phys, 2012, 83(3)：878-886.
[13]	Gomez DR, Blumenschein GR Jr, Lee JJ, et al. Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study[J]. Lancet Oncol, 2016, 17(12)：1672-1682.
[14]	Antonia SJ, Villegas A, Daniel D, et al. Durvalumab after chemoradiotherapy in stage Ⅲ non-small-cell lung cancer[J]. N Engl J Med, 2017, 377(20)：1919-1929.
[15]	Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial[J]. Lancet, 2019, 393(10185)：2051-2058.
[16]	Brooks ED, Chang JY. Time to abandon single-site irradiation for inducing abscopal effects[J]. Nat Rev Clin Oncol, 2019, 16(2)：123-135.
[17]	Palma DA, Olson R, Harrow S, et al. Stereotactic ablative radiotherapy for the comprehensive treatment of oligometastatic cancers: long-term results of the SABR-COMET phase II randomized trial[J]. J Clin Oncol, 2020, 38(25)：2830-2838.
[18]	Wijetunga NA, Dos Anjos CH, Zhi WI, et al. Long-term disease control and survival observed after stereotactic ablative body radiotherapy for oligometastatic breast cancer[J]. Cancer Med, 2021, 10(15)：5163-5174.
[19]	张勇，余一朗，单鹏飞，等. 乳腺癌患者改良根治术后复发转移的相关危险因素分析[J/CD]. 中华普外科手术学杂志(电子版), 2021, 15(4)：418-421.
[20]	黄华，阳耀国，廖聆郦，等. T1-2N0乳腺癌乳房切除术后局部区域复发风险分层模型的建立[J]. 赣南医学院学报，2022, 42(6)：563-568.

临床病理特征	全病变放射治疗组(n＝50)	非全病变放射治疗组(n＝25)	χ²值	P值
绝经
是	35(70.0)	15(60.0)	0.750	0.386
否	15(30.0)	10(40.0)	0.750	0.386
临床分期
Ⅰ期	6(12.0)	2(8.0)	0.529	0.767
Ⅱ期	24(48.0)	14(56.0)
Ⅲ期	20(40.0)	9(36.0)
病理分型
浸润性导管癌	26(52.0)	19(76.0)	0.874	0.350
其他类型	14(28.0)	6(24.0)	0.874	0.350
组织学分级
2级	20(40.0)	11(44.0)	0.110	0.740
3级	30(60.0)	14(56.0)	0.110	0.740
肿块直径
<3 cm	33(66.0)	14(56.0)	0.712	0.399
≥3 cm	17(34.0)	11(44.0)	0.712	0.399
激素受体
阴性	13(26.0)	6(24.0)	0.035	0.851
阳性	37(74.0)	19(76.0)	0.035	0.851
HER-2
阴性	37(74.0)	21(84.0)	0.951	0.330
阳性	13(26.0)	4(16.0)	0.951	0.330
Ki-67
<15%	10(20.0)	3(12.0)	1.159	0.763
15%~30%	8(16.0)	4(16.0)
>30%	30(60.0)	16(64.0)
不详	2(4.0)	2(8.0)
寡转移放射治疗部位
骨	15(30.0)	15(60.0)	16.658	<0.001^a
肺	14(28.0)	8(32.0)
淋巴结	19(38.0)	0(0)
其他部位	2(4.0)	2(8.0)
累及器官数
1个	50(100)	17(68.0)		<0.001^a
2~3个	0(0)	8(32.0)		<0.001^a
最终广泛转移
是	13(26.0)	16(64.0)	10.148	0.001
否	37(74.0)	9(36.0)	10.148	0.001
术后内分泌治疗
是	38(76.0)	13(52.0)	4.412	0.036
否	12(24.0)	12(48.0)	4.412	0.036
术后辅助放射治疗
是	22(44.0)	6(24.0)	2.850	0.091
否	28(56.0)	19(76.0)	2.850	0.091
术后辅助化疗
是	46(92.0)	25(100.0)	－	0.294^a
否	4(8.0)	0(0.0)

临床病理特征	全病变放射治疗组(n＝50)	非全病变放射治疗组(n＝25)	χ²值	P值
绝经
是	35(70.0)	15(60.0)	0.750	0.386
否	15(30.0)	10(40.0)	0.750	0.386
临床分期
Ⅰ期	6(12.0)	2(8.0)	0.529	0.767
Ⅱ期	24(48.0)	14(56.0)
Ⅲ期	20(40.0)	9(36.0)
病理分型
浸润性导管癌	26(52.0)	19(76.0)	0.874	0.350
其他类型	14(28.0)	6(24.0)	0.874	0.350
组织学分级
2级	20(40.0)	11(44.0)	0.110	0.740
3级	30(60.0)	14(56.0)	0.110	0.740
肿块直径
<3 cm	33(66.0)	14(56.0)	0.712	0.399
≥3 cm	17(34.0)	11(44.0)	0.712	0.399
激素受体
阴性	13(26.0)	6(24.0)	0.035	0.851
阳性	37(74.0)	19(76.0)	0.035	0.851
HER-2
阴性	37(74.0)	21(84.0)	0.951	0.330
阳性	13(26.0)	4(16.0)	0.951	0.330
Ki-67
<15%	10(20.0)	3(12.0)	1.159	0.763
15%~30%	8(16.0)	4(16.0)
>30%	30(60.0)	16(64.0)
不详	2(4.0)	2(8.0)
寡转移放射治疗部位
骨	15(30.0)	15(60.0)	16.658	<0.001^a
肺	14(28.0)	8(32.0)
淋巴结	19(38.0)	0(0)
其他部位	2(4.0)	2(8.0)
累及器官数
1个	50(100)	17(68.0)		<0.001^a
2~3个	0(0)	8(32.0)		<0.001^a
最终广泛转移
是	13(26.0)	16(64.0)	10.148	0.001
否	37(74.0)	9(36.0)	10.148	0.001
术后内分泌治疗
是	38(76.0)	13(52.0)	4.412	0.036
否	12(24.0)	12(48.0)	4.412	0.036
术后辅助放射治疗
是	22(44.0)	6(24.0)	2.850	0.091
否	28(56.0)	19(76.0)	2.850	0.091
术后辅助化疗
是	46(92.0)	25(100.0)	－	0.294^a
否	4(8.0)	0(0.0)

临床病理特征	例数	5年LC(%)	χ²值	P值	5年PFS(%)	χ²值	P值	5年OS(%)	χ²值	P值
是否绝经
是	50	64.1	0.155	0.694	73.3	0.420	0.517	66.5	0.229	0.632
否	25	58.4	0.155	0.694	58.6	0.420	0.517	56.6	0.229	0.632
临床分期
Ⅰ期	8	83.3	0.409	0.815	87.5	0.079	0.961	83.3	0.367	0.832
Ⅱ期	38	66.4			69.4			68.7
Ⅲ期	29	52.4			65.1			55.1
病理分型
浸润性导管癌	55	58.0	0.249	0.618	66.0	0.014	0.907	60.9	0.183	0.669
其他类型	20	79.5	0.249	0.618	78.4	0.014	0.907	77.4	0.183	0.669
组织学分级
2级	31	88.5	6.783	0.009	89.5	7.902	0.005	89.2	6.813	0.009
3级	44	48.7	6.783	0.009	54.0	7.902	0.005	50.6	6.813	0.009
肿块直径
<3 cm	47	72.4	4.751	0.029	77.1	3.690	0.055	70.1	4.042	0.044
≥3 cm	28	49.8	4.751	0.029	51.8	3.690	0.055	55.3	4.042	0.044
激素受体
阴性	19	63.0	1.596	0.206	60.5	0.792	0.373	67.7	1.909	0.167
阳性	56	66.2	1.596	0.206	72.1	0.792	0.373	66.2	1.909	0.167
HER-2
阴性	58	63.4	0.016	0.900	67.7	0.016	0.900	65.6	0.363	0.547
阳性	17	76.6	0.016	0.900	77.2	0.016	0.900	76.6	0.363	0.547
Ki-67
<15%	13	72.9	2.910	0.406	75.5	2.420	0.490	72.7	4.415	0.220
15%~30%	12	66.7			75.0			80.0
>30%	46	70.6			69.9			67.8
不详	4	37.5			37.5			37.5
寡转移放射治疗部位
骨	30	66.3	2.462	0.482	69.2	0.929	0.818	66.3	2.717	0.437
肺	22	58.2			65.7			67.8
淋巴结	19	70.4			72.2			59.0
其他	4	75.0			66.7			50.0
全病变放射治疗
是	50	87.3	15.669	<0.001	88.9	17.381	<0.001	82.5	15.416	<0.001
否	25	24.0	15.669	<0.001	22.0	17.381	<0.001	22.7	15.416	<0.001
累及器官数
1个	67	66.4	2.360	0.125	71.1	1.668	0.197	67.9	3.075	0.080
2~3个	8	43.8	2.360	0.125	45.7	1.668	0.197	40.0	3.075	0.080
最终广泛转移
否	46	100	24.304	<0.001	100	36.045	<0.001	100	23.637	<0.001
是	29	33.4	24.304	<0.001	27.8	36.045	<0.001	35.9	23.637	<0.001
术后内分泌治疗
是	51	80.0	4.733	0.030	85.5	5.323	0.021	81.2	4.481	0.034
否	24	40.0	4.733	0.030	39.8	5.323	0.021	42.0	4.481	0.034
术后辅助放射治疗
是	28	88.9	5.691	0.017	89.8	4.448	0.035	52.8	5.412	0.020
否	47	50.6	5.691	0.017	57.7	4.448	0.035	88.9	5.412	0.020
术后辅助化疗
是	71	63.8	0.456	0.499	67.9	0.456	0.499	55.5	0.340	0.560
否	4	100	0.456	0.499	100	0.456	0.499	100	0.340	0.560

临床病理特征	例数	5年LC(%)	χ²值	P值	5年PFS(%)	χ²值	P值	5年OS(%)	χ²值	P值
是否绝经
是	50	64.1	0.155	0.694	73.3	0.420	0.517	66.5	0.229	0.632
否	25	58.4	0.155	0.694	58.6	0.420	0.517	56.6	0.229	0.632
临床分期
Ⅰ期	8	83.3	0.409	0.815	87.5	0.079	0.961	83.3	0.367	0.832
Ⅱ期	38	66.4			69.4			68.7
Ⅲ期	29	52.4			65.1			55.1
病理分型
浸润性导管癌	55	58.0	0.249	0.618	66.0	0.014	0.907	60.9	0.183	0.669
其他类型	20	79.5	0.249	0.618	78.4	0.014	0.907	77.4	0.183	0.669
组织学分级
2级	31	88.5	6.783	0.009	89.5	7.902	0.005	89.2	6.813	0.009
3级	44	48.7	6.783	0.009	54.0	7.902	0.005	50.6	6.813	0.009
肿块直径
<3 cm	47	72.4	4.751	0.029	77.1	3.690	0.055	70.1	4.042	0.044
≥3 cm	28	49.8	4.751	0.029	51.8	3.690	0.055	55.3	4.042	0.044
激素受体
阴性	19	63.0	1.596	0.206	60.5	0.792	0.373	67.7	1.909	0.167
阳性	56	66.2	1.596	0.206	72.1	0.792	0.373	66.2	1.909	0.167
HER-2
阴性	58	63.4	0.016	0.900	67.7	0.016	0.900	65.6	0.363	0.547
阳性	17	76.6	0.016	0.900	77.2	0.016	0.900	76.6	0.363	0.547
Ki-67
<15%	13	72.9	2.910	0.406	75.5	2.420	0.490	72.7	4.415	0.220
15%~30%	12	66.7			75.0			80.0
>30%	46	70.6			69.9			67.8
不详	4	37.5			37.5			37.5
寡转移放射治疗部位
骨	30	66.3	2.462	0.482	69.2	0.929	0.818	66.3	2.717	0.437
肺	22	58.2			65.7			67.8
淋巴结	19	70.4			72.2			59.0
其他	4	75.0			66.7			50.0
全病变放射治疗
是	50	87.3	15.669	<0.001	88.9	17.381	<0.001	82.5	15.416	<0.001
否	25	24.0	15.669	<0.001	22.0	17.381	<0.001	22.7	15.416	<0.001
累及器官数
1个	67	66.4	2.360	0.125	71.1	1.668	0.197	67.9	3.075	0.080
2~3个	8	43.8	2.360	0.125	45.7	1.668	0.197	40.0	3.075	0.080
最终广泛转移
否	46	100	24.304	<0.001	100	36.045	<0.001	100	23.637	<0.001
是	29	33.4	24.304	<0.001	27.8	36.045	<0.001	35.9	23.637	<0.001
术后内分泌治疗
是	51	80.0	4.733	0.030	85.5	5.323	0.021	81.2	4.481	0.034
否	24	40.0	4.733	0.030	39.8	5.323	0.021	42.0	4.481	0.034
术后辅助放射治疗
是	28	88.9	5.691	0.017	89.8	4.448	0.035	52.8	5.412	0.020
否	47	50.6	5.691	0.017	57.7	4.448	0.035	88.9	5.412	0.020
术后辅助化疗
是	71	63.8	0.456	0.499	67.9	0.456	0.499	55.5	0.340	0.560
否	4	100	0.456	0.499	100	0.456	0.499	100	0.340	0.560

Please choose a citation manager

Content to export