Radiation Oncology/Breast/Metastatic

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Metastatic Breast Cancer



Local Control[edit]

  • Tata Memorial; India; 2013 (2005-2013) Abstract Link -- "Surgical removal of primary tumor and axillary lymph nodes in women with metastatic breast cancer at first presentation: A randomized controlled trial" (Badwe R, San Antonio Breast Conference Abstract S2-02, 2013)
    • Randomized. 350 patients, metastatic breast cancer, status post anthracycline chemotherapy with objective tumor response. Arm 1) loco-regional treatment (lumpectomy or mastectomy and ALND followed by RT) versus Arm 2) No loco-regional treatment. Endocrine therapy as indicated. Median F/U 1.5 years
    • Outcome: Median OS LRT 19 months versus No LRT 20.5 months (NS); 2-year OS 41% vs 43%. No difference afer adjusting for prognostic factors
    • Conclusion: Loco-regional treatment has no impact on overall survival, and should be reserved for women who need it for palliative reasons
  • Turkish Study MF07-01 Abstract Link -- "Early follow up of a randomized trial evaluating resection of the primary breast tumor in women presenting with de novo stage IV breast cancer; Turkish study (protocol MF07-01)" (Soran A, San Antonio Breast Conference Abstract S2-03, 2013)
    • Randomized. 278 patients, metastatic breast cancer. Arm 1) loco-regional therapy (mastectomy or lumpectomy + radiation and SNB/ALND) before initiating systemic therapy versus Arm 2) No loco-regional treatment, systemic therapy only. Bone-only 46%; no bone 29%, both bone and other 25%. Median F/U 1.7 years.
    • Outcome: 4.5 year OS LRT 35% versus No LRT 31% (NS). Bone-only subgroup mean OS 3.2 years versus 2.7 years (NS); solitary bone only disease statistically significant (numbers not given)
    • Conclusion: Overall survival similar; but patients with solitary bone metastases had a survival benefit
  • Hawaii; 2009 PMID 19876731 -- "Loco-regional treatment in metastatic breast cancer patients: Is there a survival benefit?" (Ly BH, Breast Cancer Res Treat. 2009 Oct 30. [Epub ahead of print])
    • Literature review. 13 studies evaluating loco-regional treatment (surgery, or surgery + RT, RT)
    • Outcome: Median OS no surgery 12-28 months vs. surgery 25-42 months; 3-year OS 17-79% vs. 28-95%
    • Conclusion: Possibility of surgery and/or RT following induction should be left to individual practice

Zoledronic Acid (Zometa) + RT[edit]

  • Turkey (2003-2005) -- Zoledronic acid + RT 30/10 vs. Zoledronic acid + RT 15/5
    • Randomized. 100 patients, at least one bone metastasis, life expectancy >6 months. Excluded pathologic fractures, prior RT to that area, prior treatment with zoledronic acid, brain mets. Zoledronic acid 4 mg Q28 days, starting day 1 of RT. Used objective measure (MRI, bone scan) and subjective end points (pain, analgesic score, visual analog score)
    • 2009 PMID 19484483 -- "Zoledronic acid concurrent with either high- or reduced-dose palliative radiotherapy in the management of the breast cancer patients with bone metastases: a phase IV randomized clinical study." (Atahan L, Support Care Cancer. 2009 May 31. [Epub ahead of print]). Minimum F/U 6 months
      • Outcome: No difference in time-to-first skeletal event, rate of first-skeleta-event, time-to-response, rate of response, or duration of response. Higher satisfaction in shorter 15/5 arm
      • Conclusion: Concomitant use of zoledronic acid and RT safe