Locoregional radiotherapy improves survival in Stage IV breast cancer
By Catherine Nieman Sims
11 February 2009
J Clin Oncol 2009; Advance online publication
MedWire News: Locoregional treatment (LRT), and in particular locoregional radiotherapy (LRR), is associated with improved survival in breast cancer patients with synchronous metastases, a study shows.
It has been suggested that LRT through surgical removal of the primary tumor improves survival in patients with advanced breast cancer. The effect of LRR, as an alternative form of LRT, has been studied less in these patients.
At the Centre René Huguenin (Saint Cloud, France), where exclusive LRR to the primary tumor and regional lymphatics is generally preferred to surgery, Romuald Le Scodan and colleagues followed the outcome of patients treated between 1980 and 2004.
During this period, 3.2% of all patients presented with an intact primary tumor and synchronous metastases. Patients were divided into two groups: group A (n=320) received radiotherapy alone (exclusive LRR, n=249), surgery followed by radiotherapy (n=41), or surgery alone (n=30); group B (n=260) received no LRT. Median follow-up was 39 months.
The researchers found that overall survival (OS) was increased by LRT, as shown by a 3-year OS rate of 43.4% in group A versus 26.7% in group B. In addition to LRT, univariate analysis showed that visceral metastases, multiple metastasis sites, chemotherapy, and endocrine therapy all significantly affected OS.
Among patients with visceral metastases, the 3-year OS rate was 34.2% in group A compared with 17.8% in group B. LRT was also beneficial in patients with multiple metastatic sites, but had no significant effect in those with bone metastases alone.
Following multivariate analysis, the authors found LRT was associated with a 30% reduction in the risk for death overall; further analysis the associated risk reduction was 55% for up to 1 year after diagnosis and 34% 1 year or more after diagnosis with LRT. Age at diagnosis, visceral metastases, involvement of multiple sites, and endocrine treatment were all also independent predictors of OS.
The authors conclude that “LRT, consisting mainly of exclusive LRR, was associated with improved survival in breast cancer patients with synchronous metastases.” They suggest that “exclusive LRR may thus represent an active alternative to surgery.”
This study is published in the
Journal of Clinical Oncology.
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www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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