- Email: [email protected]
Local Radiotherapy Improves Survival in Stage IV Breast Cancer Patients Who Undergo Surgical Resection of the Primary Tumor
I. J. Radiation Oncology d Biology d Physics
S156
1095
Volume 72, Number 1, Supplement, 2008
Local Radiotherapy Improves Survival in Stage IV Breast Cancer Patients Who Undergo Surgical Resection of the Primary Tumor
W. Tereffe, J. E. Lang, R. Rao, L. Feng, T. K. Yu, J. L. Oh, W. A. Woodward, K. K. Hunt, G. N. Hortobagyi, G. V. Babiera M.D. Anderson Cancer Center, Houston, TX Purpose/Objective(s): Recent cancer registry analyses suggest that extirpation of the primary tumor improves survival in patients with Stage IV breast cancer. Additional data are needed to clarify the role of radiation in these patients. The goal of this study was to assess the impact of local radiotherapy (RT) on overall (OS) and progression-free survival (PFS) in patients with Stage IV breast cancer treated with surgical resection of the primary tumor. Materials/Methods: We utilized a 219-patient dataset of Stage IV patients for which previous analysis demonstrated that surgery improved OS and PFS. Of 219 patients, 39% (n = 85) underwent surgery. Median survival was 53 months for the surgical group and 37.2 months for the non-surgical group. Most patients received chemotherapy (n = 132, 60%), hormonal therapy (n = 79, 36%), or both (n = 2, 1%); only 6 patients (3%) received no systemic therapy. Data on radiation use were retrospectively collected on all patients, of whom 11% (n = 23) received RT after surgery, 3.2% (n = 7) RT prior to surgery, and 7.3% (n = 16) RT only without surgery. Median RT dose (including boosts) was 60 Gy (range, 16-75 Gy); median dose per fraction was 250 cGy (range, 150-600 cGy). Actuarial survival rates were calculated by Kaplan-Meier method, and a Cox proportional hazards model was used for multivariate analysis (MVA). Results: With a median follow-up of 74.2 months, the actuarial 5-year OS for the entire cohort was 48% with RT vs 35% without RT (p = 0.011); 5-year PFS was 28% with RT vs 13% without RT (p = 0.021). Among the 85 patients who underwent surgery, use of RT was associated with improved 5-year OS (66% vs 28%, p = 0.004) and PFS (42% vs 27%, p = 0.032). When sequencing of RT and surgery was assessed, improved outcomes were noted with RT prior to vs after surgery (OS 100% vs 66%, p = 0.007; PFS 79% vs 43%, p = 0.062), although the number treated with preoperative RT was small (n = 7). Regional nodal RT exerted no effect on OS or PFS. On MVA of the entire 219-patient cohort, surgery, upfront anthracycline chemotherapy, ER status, nodal involvement, and number of distant metastases were significant predictors of OS. Conclusions: In this selected cohort, local radiotherapy further improved OS and PFS in patients with Stage IV breast cancer who underwent extirpation of the primary tumor. Our surgical results are consistent with similar analyses conducted using SEER and other large database registries; to our knowledge this is the first report to assess the incremental benefit of RT. The role of surgery and radiation to the primary tumor in Stage IV breast cancer patients deserves to be studied in a prospective multi-center randomized trial. Author Disclosure: W. Tereffe, None; J.E. Lang, None; R. Rao, None; L. Feng, None; T.K. Yu, None; J.L. Oh, None; W.A. Woodward, None; K.K. Hunt, None; G.N. Hortobagyi, None; G.V. Babiera, None.
1096
Oligometastatic Breast Cancer Treated with Curative Intent Stereotactic Body Radiotherapy (SBRT)
M. T. Milano, H. Zhang, S. K. Metcalfe, A. G. Muhs, P. Okunieff University of Rochester, Rochester, NY Purpose/Objective(s): The hypothesis that some patients with oligometastases may potentially be cured with local therapy is supported by prior data from our group and others. Here we present the clinical outcome of breast cancer patients treated with curative intent (defined as #5 metastases) or palliative (.5 metastases) SBRT using the Novalis Shaped Beam Radiosurgery platform. Materials/Methods: From 2001-2007, 39 breast cancer patients received curative intent SBRT (‘curative pts’), while 11 underwent palliative SBRT (‘palliative pts’). Prior to enrollment, all but 3 patients received systemic therapy for metastatic disease. All palliative pts had lesions(s) deemed potentially life threatening were they to continue to grow; only 1 patient was symptomatic from metastases. Our SBRT technique has been described previously (Milano et al, Cancer 2008). Results: Compared to palliative pts, curative pts were treated earlier in their disease course (median of 12 vs. 22 M after developing metastases). All palliative pts died from distant progression at 4-24 M (median 13 M); no patient died from local failure. The 7 palliative pts with innumerable (.25) lesions, compared to the 4 patients with 6-13 lesions, had a worse OS (median of 6 vs. 16 M, p = 0.064) and similar PFS (median 4 vs. 3 M, p = 0.2). Among curable pts, the 2Y and 4Y OS are 74% and 64%; the MS is not yet reached. The 2Y and 4Y PFS are 44% and 40%; the median PFS is 23 M. The 4Y DC is 46%. The 4Y patient LC is 78% and 4Y lesion LC is 89%; no lesions failed locally after 18 M. 26 patients are alive at 6-81 M (median, 41 M); 19 are alive with no evidence of recurrent disease. Curative pts with bone-only metastases (n = 8) fared better with respect to OS, PFS, and DC. All 8 patients treated curatively with bone-only disease are alive with no evidence of recurrent disease at 7-77 months (median, 35 M). Curative pts receiving SBRT for progressing lesions (vs. stable or regressing lesions) and those with .1 treated lesions experienced worse survival and disease control. Progressing lesions were significantly larger than stable or responding lesions (p = 0.0009). Net GTV (sum of gross target volumes) was the only variable significant or borderline significant on MVA for curative pt survival and disease control outcomes. Lesion GTV was the only variable significant on MVA for lesion LC. Conclusions: Breast cancer patients treated with curative intent SBRT fare well with respect to disease control and survival. Palliation of select lesions with SBRT did not appear to impact distant progression, but did afford excellent local control of treated tumors. Further studies are needed to assess the impact of SBRT on the disease course in women with limited breast cancer metastases. A SWOG study will soon open to investigate this in a cooperative group setting. Author Disclosure: M.T. Milano, None; H. Zhang, None; S.K. Metcalfe, None; A.G. Muhs, None; P. Okunieff, None.
1097
Comparison of Locoregional Recurrence with Mastectomy versus Breast Conserving Surgery in Pregnancy Associated Breast Cancer (PABC)
S. Beriwal, B. J. Rungruang, A. Soran, D. Thull, J. L. Kelley, P. Sukumvanich University of Pittsburgh Medical Center, Pittsburgh, PA Purpose/Objective(s): Breast cancer is the second most common malignancy associated with pregnancy. The locoregional recurrence and outcome with PABC is presumed to be similar to age and stage matched non-pregnant patients. We herein analyze and
S156
1095
Volume 72, Number 1, Supplement, 2008
Local Radiotherapy Improves Survival in Stage IV Breast Cancer Patients Who Undergo Surgical Resection of the Primary Tumor
W. Tereffe, J. E. Lang, R. Rao, L. Feng, T. K. Yu, J. L. Oh, W. A. Woodward, K. K. Hunt, G. N. Hortobagyi, G. V. Babiera M.D. Anderson Cancer Center, Houston, TX Purpose/Objective(s): Recent cancer registry analyses suggest that extirpation of the primary tumor improves survival in patients with Stage IV breast cancer. Additional data are needed to clarify the role of radiation in these patients. The goal of this study was to assess the impact of local radiotherapy (RT) on overall (OS) and progression-free survival (PFS) in patients with Stage IV breast cancer treated with surgical resection of the primary tumor. Materials/Methods: We utilized a 219-patient dataset of Stage IV patients for which previous analysis demonstrated that surgery improved OS and PFS. Of 219 patients, 39% (n = 85) underwent surgery. Median survival was 53 months for the surgical group and 37.2 months for the non-surgical group. Most patients received chemotherapy (n = 132, 60%), hormonal therapy (n = 79, 36%), or both (n = 2, 1%); only 6 patients (3%) received no systemic therapy. Data on radiation use were retrospectively collected on all patients, of whom 11% (n = 23) received RT after surgery, 3.2% (n = 7) RT prior to surgery, and 7.3% (n = 16) RT only without surgery. Median RT dose (including boosts) was 60 Gy (range, 16-75 Gy); median dose per fraction was 250 cGy (range, 150-600 cGy). Actuarial survival rates were calculated by Kaplan-Meier method, and a Cox proportional hazards model was used for multivariate analysis (MVA). Results: With a median follow-up of 74.2 months, the actuarial 5-year OS for the entire cohort was 48% with RT vs 35% without RT (p = 0.011); 5-year PFS was 28% with RT vs 13% without RT (p = 0.021). Among the 85 patients who underwent surgery, use of RT was associated with improved 5-year OS (66% vs 28%, p = 0.004) and PFS (42% vs 27%, p = 0.032). When sequencing of RT and surgery was assessed, improved outcomes were noted with RT prior to vs after surgery (OS 100% vs 66%, p = 0.007; PFS 79% vs 43%, p = 0.062), although the number treated with preoperative RT was small (n = 7). Regional nodal RT exerted no effect on OS or PFS. On MVA of the entire 219-patient cohort, surgery, upfront anthracycline chemotherapy, ER status, nodal involvement, and number of distant metastases were significant predictors of OS. Conclusions: In this selected cohort, local radiotherapy further improved OS and PFS in patients with Stage IV breast cancer who underwent extirpation of the primary tumor. Our surgical results are consistent with similar analyses conducted using SEER and other large database registries; to our knowledge this is the first report to assess the incremental benefit of RT. The role of surgery and radiation to the primary tumor in Stage IV breast cancer patients deserves to be studied in a prospective multi-center randomized trial. Author Disclosure: W. Tereffe, None; J.E. Lang, None; R. Rao, None; L. Feng, None; T.K. Yu, None; J.L. Oh, None; W.A. Woodward, None; K.K. Hunt, None; G.N. Hortobagyi, None; G.V. Babiera, None.
1096
Oligometastatic Breast Cancer Treated with Curative Intent Stereotactic Body Radiotherapy (SBRT)
M. T. Milano, H. Zhang, S. K. Metcalfe, A. G. Muhs, P. Okunieff University of Rochester, Rochester, NY Purpose/Objective(s): The hypothesis that some patients with oligometastases may potentially be cured with local therapy is supported by prior data from our group and others. Here we present the clinical outcome of breast cancer patients treated with curative intent (defined as #5 metastases) or palliative (.5 metastases) SBRT using the Novalis Shaped Beam Radiosurgery platform. Materials/Methods: From 2001-2007, 39 breast cancer patients received curative intent SBRT (‘curative pts’), while 11 underwent palliative SBRT (‘palliative pts’). Prior to enrollment, all but 3 patients received systemic therapy for metastatic disease. All palliative pts had lesions(s) deemed potentially life threatening were they to continue to grow; only 1 patient was symptomatic from metastases. Our SBRT technique has been described previously (Milano et al, Cancer 2008). Results: Compared to palliative pts, curative pts were treated earlier in their disease course (median of 12 vs. 22 M after developing metastases). All palliative pts died from distant progression at 4-24 M (median 13 M); no patient died from local failure. The 7 palliative pts with innumerable (.25) lesions, compared to the 4 patients with 6-13 lesions, had a worse OS (median of 6 vs. 16 M, p = 0.064) and similar PFS (median 4 vs. 3 M, p = 0.2). Among curable pts, the 2Y and 4Y OS are 74% and 64%; the MS is not yet reached. The 2Y and 4Y PFS are 44% and 40%; the median PFS is 23 M. The 4Y DC is 46%. The 4Y patient LC is 78% and 4Y lesion LC is 89%; no lesions failed locally after 18 M. 26 patients are alive at 6-81 M (median, 41 M); 19 are alive with no evidence of recurrent disease. Curative pts with bone-only metastases (n = 8) fared better with respect to OS, PFS, and DC. All 8 patients treated curatively with bone-only disease are alive with no evidence of recurrent disease at 7-77 months (median, 35 M). Curative pts receiving SBRT for progressing lesions (vs. stable or regressing lesions) and those with .1 treated lesions experienced worse survival and disease control. Progressing lesions were significantly larger than stable or responding lesions (p = 0.0009). Net GTV (sum of gross target volumes) was the only variable significant or borderline significant on MVA for curative pt survival and disease control outcomes. Lesion GTV was the only variable significant on MVA for lesion LC. Conclusions: Breast cancer patients treated with curative intent SBRT fare well with respect to disease control and survival. Palliation of select lesions with SBRT did not appear to impact distant progression, but did afford excellent local control of treated tumors. Further studies are needed to assess the impact of SBRT on the disease course in women with limited breast cancer metastases. A SWOG study will soon open to investigate this in a cooperative group setting. Author Disclosure: M.T. Milano, None; H. Zhang, None; S.K. Metcalfe, None; A.G. Muhs, None; P. Okunieff, None.
1097
Comparison of Locoregional Recurrence with Mastectomy versus Breast Conserving Surgery in Pregnancy Associated Breast Cancer (PABC)
S. Beriwal, B. J. Rungruang, A. Soran, D. Thull, J. L. Kelley, P. Sukumvanich University of Pittsburgh Medical Center, Pittsburgh, PA Purpose/Objective(s): Breast cancer is the second most common malignancy associated with pregnancy. The locoregional recurrence and outcome with PABC is presumed to be similar to age and stage matched non-pregnant patients. We herein analyze and