Oligometastatic Breast Cancer Patients Treated with High-Dose Chemotherapy and Targeted Radiation: Long-Term Follow-Up of a Phase II Trial

被引:2
作者
Ladbury, Colton [1 ]
Hao, Claire [1 ]
Ruel, Christopher [2 ]
Liu, Jason [1 ]
Glaser, Scott [1 ]
Amini, Arya [1 ]
Wong, Jeffrey [1 ]
Paz, Isaac [3 ]
Leong, Lucille [4 ]
Morgan, Robert [4 ]
Margolin, Kim [5 ]
Shibata, Stephen [4 ]
Frankel, Paul [2 ]
Somlo, George [4 ]
Dandapani, Savita [1 ]
机构
[1] City Hope Natl Med Ctr, Dept Radiat Oncol, Duarte, CA 91010 USA
[2] City Hope Natl Med Ctr, Div Biostat, Duarte, CA 91010 USA
[3] City Hope Natl Med Ctr, Dept Surg, Duarte, CA 91010 USA
[4] City Hope Natl Med Ctr, Dept Hematol & Hematopoiet Cell Transplantat, Duarte, CA 91010 USA
[5] St Johns Canc Inst, Dept Med Oncol, Santa Monica, CA 90404 USA
关键词
oligometastases; radiation; breast cancer; high-dose chemotherapy; STEM-CELL TRANSPLANTATION; PROGRESSION-FREE SURVIVAL; THERAPY; SUPPORT; CYCLOPHOSPHAMIDE; RADIOTHERAPY; THIOTEPA; RESCUE; IMPACT; WOMEN;
D O I
10.3390/cancers14205000
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Simple Summary Based on recent clinical trials, radiation is a standard treatment option for limited metastatic sites in metastatic breast cancer, with the potential to improve survival. This is typically given in the form of high-dose radiation called stereotactic body radiotherapy (SBRT). However, SBRT is a newer technology that is not on option for all patients and does not have long-term follow-up. Prior to the widespread implementation of SBRT, we performed a clinical trial utilizing high-dose chemotherapy and standard radiation for metastases in patients with limited metastatic breast cancer. In this research, we analyzed the long-term outcomes of these patients. We found that, despite not using SBRT, radiation provided promising long-term disease control and survival. Therefore, conventional radiation might still be considered if SBRT in not an option for a patient, and our results also help suggest what long-term outcomes of SBRT treatment might look like. Background: Patients with oligometastatic breast cancer (oMBC) may benefit from aggressive local therapy. We sought to assess the effects of consolidative radiation therapy (RT) on outcomes in oMBC patients treated on a prospective phase II trial of high-dose chemotherapy (HDCT). Methods: Between 2005 and 2009, 12 patients with oMBC (<= 3 metastatic sites) cancer were treated on protocol. Patients were to receive tandem HDCT supported by hematopoietic cell rescue (HCR). All radiographically identifiable oligometastatic sites received targeted radiation. Results: HDCT was initiated at a median of 6.7 (3.5-12.7) months after diagnosis of oMBC. Hormone receptors (HR) were positive in 91.6% of patients, and HER2 was overexpressed in 25% of patients. Median radiation dose (EQD2) was 41.2 (37.9-48.7) Gy. Median follow-up was 13.1 (6.8-15.1) years for living patients. Ten-year PFS and OS were 33% (95%CI, 10-59%) and 55% (95%CI, 22-79%), respectively. Durable local control of treated lesions was 87.5%. At the last follow up, two patients remained progression free and two more were without evidence of disease following additional salvage treatment. Conclusions: Although modern systemic therapies have obviated the use of HDC, aggressive local therapy warrants further evaluation and fractionated radiotherapy is a viable alternative if SBRT is not available.
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页数:11
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