Metastasis-directed stereotactic radiotherapy in patients with breast cancer: results of an international multicenter cohort study

Metastasis-directed therapy (MDT) for oligometastatic breast cancer (≤ 5 metastases) has shown little effect in specific scenarios of randomized trials. Therefore, we aimed to assess outcomes after metastasis-directed stereotactic radiotherapy (SRT) in various clinical scenarios. We conducted an international retrospective cohort study in thirteen centers including breast cancer patients receiving SRT to any metastatic site. Outcomes included local recurrence (LR), progression-free survival (PFS), and overall survival (OS). Cumulative incidence analysis was used for LR, Kaplan-Meier estimates for PFS and OS. Covariables included patient, disease, and SRT characteristics. We performed univariable and multivariable analyses (MVA). Among 444 patients, 751 metastases were treated with SRT. Of these, 73% were intracranial and 27% extracranial lesions. Oligometastatic disease (OMD) was present in 66% of the patients. LR after two years occurred significantly more often in intracranial (25%) versus extracranial lesions (7%). In MVA of patients with OMD treated for intracranial sites, higher performance status was significantly associated with longer PFS. Further, higher performance status, biologic subtype (HR-pos./HER2-pos.), and MDT to all sites were significantly associated with longer OS. In MVA of oligometastatic patients treated for extracranial sites, biologic subtype (HR-neg./HER2-pos.) and synchronous metastasis were associated with significantly longer PFS, whereas higher grading was associated with significantly shorter PFS. Moreover, biologic subtype (HR-neg./HER2-neg.) was associated with significantly shorter OS. In conclusion, the role of MDT for breast cancer may vary per clinical scenario. Patients with OMD treated for intracranial lesions who had MDT to all sites showed superior OS. Our results should be validated prospectively.

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Publication Details

Journal
Clinical & Experimental Metastasis
Published
2024-12-21
DOI
https://doi.org/10.1007/s10585-024-10326-x
Citations
1
Primary Topic
Brain Metastases and Treatment
Type
article
Field-Weighted Citation Impact
0.42
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article

Metastasis-directed stereotactic radiotherapy in patients with breast cancer: results of an international multicenter cohort study

David Kaul, Eleni Gkika, Hossein Hemmatazad, Susanne Rogers et al.
1 citations
Clinical & Experimental Metastasis
Brain Metastases and Treatment
0.42
article

Metastasis-directed stereotactic radiotherapy in patients with breast cancer: results of an international multicenter cohort study

David Kaul, Eleni Gkika, Hossein Hemmatazad, Susanne Rogers, Alexander Fabian, Andrea Wittig, Montserrat Pazos, Oliver Blanck, Judit Boda‐Heggemann, Heiko Karle, David A. Krug, Katharina Hintelmann, Juliane Hörner‐Rieber, Denise Bernhardt, Daniel Buergy, Eugenia Vlaskou Badra, Thomas Brunner, Fabian Weykamp, Nora Mehrhof, Konstantinos Ferentinos, Alicia S. Bicu, Marciana Nona-Duma, Tim Lange, Stefan Janssen
article en
1 citations

Abstract

Metastasis-directed therapy (MDT) for oligometastatic breast cancer (≤ 5 metastases) has shown little effect in specific scenarios of randomized trials. Therefore, we aimed to assess outcomes after metastasis-directed stereotactic radiotherapy (SRT) in various clinical scenarios. We conducted an international retrospective cohort study in thirteen centers including breast cancer patients receiving SRT to any metastatic site. Outcomes included local recurrence (LR), progression-free survival (PFS), and overall survival (OS). Cumulative incidence analysis was used for LR, Kaplan-Meier estimates for PFS and OS. Covariables included patient, disease, and SRT characteristics. We performed univariable and multivariable analyses (MVA). Among 444 patients, 751 metastases were treated with SRT. Of these, 73% were intracranial and 27% extracranial lesions. Oligometastatic disease (OMD) was present in 66% of the patients. LR after two years occurred significantly more often in intracranial (25%) versus extracranial lesions (7%). In MVA of patients with OMD treated for intracranial sites, higher performance status was significantly associated with longer PFS. Further, higher performance status, biologic subtype (HR-pos./HER2-pos.), and MDT to all sites were significantly associated with longer OS. In MVA of oligometastatic patients treated for extracranial sites, biologic subtype (HR-neg./HER2-pos.) and synchronous metastasis were associated with significantly longer PFS, whereas higher grading was associated with significantly shorter PFS. Moreover, biologic subtype (HR-neg./HER2-neg.) was associated with significantly shorter OS. In conclusion, the role of MDT for breast cancer may vary per clinical scenario. Patients with OMD treated for intracranial lesions who had MDT to all sites showed superior OS. Our results should be validated prospectively.

Clinical & Experimental MetastasisVol. 42(1)
University of Bern (CH), University of Bonn (DE), Universität Hamburg (DE), University of Potsdam (DE), German Cancer Research Center (DE), Johannes Gutenberg University Mainz (DE), European University Cyprus (CY), University of Zurich (CH), Heidelberg University (DE), University Hospital Bonn (DE), University of Applied Sciences Potsdam (DE), University Hospital of Bern (CH), University Medical Center Freiburg (DE), University Hospital Heidelberg (DE), LMU Klinikum (DE), University of Cyprus (CY), Medizinische Hochschule Hannover (DE), MSH Medical School Hamburg – University of Applied Sciences and Medical University (DE), Düsseldorf University Hospital (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Graz University Hospital (AT), University Hospital of Zurich (CH), Heidelberger Institut für Radioonkologie (DE), Helios Hospital Schwerin (DE), University Medical Center Hamburg-Eppendorf (DE), National Center for Tumor Diseases (DE), University Hospital Schleswig-Holstein (DE), Universitätsklinikum Würzburg (DE), University Medical Centre Mannheim (DE), Kantonsspital Aarau (CH), Heinrich Heine University Düsseldorf (DE), Technical University of Munich (DE), Charité - Universitätsmedizin Berlin (DE), Ludwig-Maximilians-Universität München (DE), University of Lübeck (DE)
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Brain Metastases and Treatment
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