Significance of liver metastasis volume in breast cancer patients treated with stereotactic body radiotherapy

Springer Science and Business Media LLC - Tập 198 - Trang 247-253 - 2021
Ezgi Oymak1, Ozan Cem Guler2, Cem Onal2
1Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
2Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey

Tóm tắt

This study analyzed the impact of liver metastasis (LM) volume on treatment outcomes in breast cancer (BC) patients treated with stereotactic body radiotherapy (SBRT). This single-institution retrospective analysis included 40 oligometastatic (≤ 5 metastases) BC patients with 58 liver metastases treated with SBRT between April 2013 and March 2021. The prognostic factors for local control (LC), overall survival (OS), and progression-free survival (PFS) rates were assessed. Median follow-up time was 28.1 months. Isolated and solitary LM were seen in 26 (65%) and 24 (60%) patients, respectively. Median time to disease recurrence was 10.7 months post liver SBRT. The 2‑year OS, PFS, and LC rates were 71.4%, 27.5%, and 86.8%, respectively. In univariate analysis, patients with a gross tumor volume (GTV) of ≤ 6 cc and a planning target volume (PTV) of ≤ 38 cc demonstrated a significantly better median OS than those with GTV > 6 cc and PTV > 38 cc. In multivariate analysis, the predictive factors for worse OS were GTV > 6 cc (HR = 3.07 [95% CI, 1.14–8.22; p = 0.03]) and PTV > 38 cc (HR = 5.91 [95% CI, 1.92–18.21; p = 0.002]). No significant factor for PFS was found. Only 2 patients experienced rib fracture at 4 and 6 months post treatment, and 1 patient had a grade II duodenal ulcer. Liver SBRT is an effective and safe treatment option for oligometastatic BC patients with excellent LC, promising survival, and limited toxicity. Patients with smaller tumors displayed better OS than their counterparts, validating the effectiveness of a local treatment for this group.

Tài liệu tham khảo

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492 Largillier R, Ferrero JM, Doyen J, Barriere J, Namer M, Mari V et al (2008) Prognostic factors in 1,038 women with metastatic breast cancer. Ann Oncol 19:2012–2019. https://doi.org/10.1093/annonc/mdn424 Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13:8–10. https://doi.org/10.1200/jco.1995.13.1.8 Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C et al (2019) Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet 393:2051–2058. https://doi.org/10.1016/s0140-6736(18)32487-5 Jakobs TF, Hoffmann RT, Schrader A, Stemmler HJ, Trumm C, Lubienski A et al (2009) CT-guided radiofrequency ablation in patients with hepatic metastases from breast cancer. Cardiovasc Intervent Radiol 32:38–46. https://doi.org/10.1007/s00270-008-9384-7 Milano MT, Katz AW, Zhang H, Okunieff P (2012) Oligometastases treated with stereotactic body radiotherapy: long-term follow-up of prospective study. Int J Radiat Oncol Biol Phys 83:878–886. https://doi.org/10.1016/j.ijrobp.2011.08.036 Meloni MF, Andreano A, Laeseke PF, Livraghi T, Sironi S, Lee FT Jr (2009) Breast cancer liver metastases: US-guided percutaneous radiofrequency ablation—intermediate and long-term survival rates. Radiology 253:861–869. https://doi.org/10.1148/radiol.2533081968 Barral M, Auperin A, Hakime A, Cartier V, Tacher V, Otmezguine Y et al (2016) Percutaneous thermal ablation of breast cancer metastases in oligometastatic patients. Cardiovasc Intervent Radiol 39:885–893. https://doi.org/10.1007/s00270-016-1301-x Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT (2017) Normal tissue constraints for abdominal and thoracic stereotactic body radiotherapy. Semin Radiat Oncol 27:197–208. https://doi.org/10.1016/j.semradonc.2017.02.001 Méndez Romero A, Keskin-Cambay F, van Os RM, Nuyttens JJ, Heijmen BJM, IJzermans JNM et al (2017) Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy. Rep Pract Oncol Radiother 22:126–131. https://doi.org/10.1016/j.rpor.2016.10.003 Scorsetti M, Comito T, Tozzi A, Navarria P, Fogliata A, Clerici E et al (2015) Final results of a phase II trial for stereotactic body radiation therapy for patients with inoperable liver metastases from colorectal cancer. J Cancer Res Clin Oncol 141:543–553. https://doi.org/10.1007/s00432-014-1833-x Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ et al (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 27:1572–1578. https://doi.org/10.1200/jco.2008.19.6329 Onal C, Guler OC, Yildirim BA (2018) Treatment outcomes of breast cancer liver metastasis treated with stereotactic body radiotherapy. Breast 42:150–156. https://doi.org/10.1016/j.breast.2018.09.006 Su TS, Liang P, Zhou Y, Huang Y, Cheng T, Qu S et al (2020) Stereotactic body radiation therapy vs. transarterial chemoembolization in inoperable barcelona clinic liver cancer stage a hepatocellular carcinoma: a retrospective, propensity-matched analysis. Front Oncol 10:347. https://doi.org/10.3389/fonc.2020.00347 Jun BG, Kim SG, Kim YD, Cheon GJ, Han KH, Yoo JJ et al (2018) Combined therapy of transarterial chemoembolization and stereotactic body radiation therapy versus transarterial chemoembolization for 〈/=5 cm hepatocellular carcinoma: propensity score matching analysis. PLoS ONE 13:e206381. https://doi.org/10.1371/journal.pone.0206381 Kim N, Kim HJ, Won JY, Kim DY, Han KH, Jung I et al (2019) Retrospective analysis of stereotactic body radiation therapy efficacy over radiofrequency ablation for hepatocellular carcinoma. Radiother Oncol 131:81–87. https://doi.org/10.1016/j.radonc.2018.12.013 Scorsetti M, Arcangeli S, Tozzi A, Comito T, Alongi F, Navarria P et al (2013) Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial. Int J Radiat Oncol Biol Phys 86:336–342. https://doi.org/10.1016/j.ijrobp.2012.12.021 Berkovic P, Gulyban A, Nguyen PV, Dechambre D, Martinive P, Jansen N et al (2017) Stereotactic robotic body radiotherapy for patients with unresectable hepatic oligorecurrence. Clin Colorectal Cancer 16:349–357.e1. https://doi.org/10.1016/j.clcc.2017.03.006 Mahadevan A, Blanck O, Lanciano R, Peddada A, Sundararaman S, D’Ambrosio D et al (2018) Stereotactic body radiotherapy (SBRT) for liver metastasis—clinical outcomes from the international multi-institutional RSSearch(R) patient registry. Radiat Oncol 13:26. https://doi.org/10.1186/s13014-018-0969-2 Weykamp F, Konig L, Seidensaal K, Forster T, Hoegen P, Akbaba S et al (2020) Extracranial stereotactic body radiotherapy in oligometastatic or oligoprogressive breast cancer. Front Oncol 10:987. https://doi.org/10.3389/fonc.2020.00987