by Gauthier
Glemarec, Jean Louis Lacaze, Bastien Cabarrou, Richard Aziza, Eva Jouve,
Slimane Zerdoud, Eleonora De Maio, Carole Massabeau, Maxime Loo, Vincent
Esteyrie, Mony Ung, Florence Dalenc, Francoise Izar, Ciprian Chira
The Breast: Published: December 29, 2022
Purpose
Local ablative
treatment (LAT) is increasingly combined with systemic therapy in
oligometastatic breast cancer (OMBC), without a high-level evidence to support
this strategy. We evaluated the addition of LAT to systemic treatment in terms
of progression-free survival (PFS) and overall survival (OS). Secondary
endpoints were local control (LC) and toxicity. We sought to identify
prognostic factors associated with longer OS and PFS.
Methods and
materials
We identified
consecutive patients treated between 2014 and 2018 for synchronous or
metachronous OMBC (defined as ≤ 5 metastases). LAT included stereotactic body
(SBRT) and volumetric modulated arc therapy (VMAT), surgery, cryotherapy and
percutaneous radiofrequency ablation (PRA). PFS and OS were calculated and Cox
regression models analyzed for potential predictors of survival.
Results
One hundred two
patients were included (no-LAT, n = 62; LAT, n = 40). Sixty-four metastases
received LAT. Median follow-up was 50.4 months (95% CI [44.4; 53.4]). One
patient experienced grade 3 toxicity in the LAT group. Five-year PFS and OS
were 34.75% (95% CI [24.42–45.26]) and 63.21% (95% CI [50.69–73.37])
respectively. Patients receiving both LAT and systemic therapy had longer PFS
and OS than those with no-LAT ([HR 0.39, p = 0.002]) and ([HR 0.31, p = 0.01]).
The use of LAT, HER2-positive status and hormone-receptor positivity were
associated with longer PFS and OS whereas liver metastases led to worse PFS.
Conclusions
LAT was associated
with improved outcomes in OMBC when added to systemic treatment alone, without
significantly increasing toxicity. The prognostic factors identified to extend
PFS and OS may help guide clinicians in selecting patients for LAT.
