Repeated chemoembolization followed by laser-induced thermotherapy for liver metastasis of breast cancer.

OBJECTIVE

The purpose of this study was to evaluate local tumor control and survival after use of a downstaging protocol of repeated transarterial chemoembolization (TACE) with two chemotherapeutic combinations followed by laser-induced thermotherapy in the care of patients with liver metastasis of breast cancer.

SUBJECTS AND METHODS

This prospective study included 161 patients with liver metastasis of breast cancer origin. TACE (mean, 3.5 [SD, 1.3] sessions per patient; range, 1-9 sessions) was performed as downstaging treatment to achieve the size and number of metastatic lesions that met the requirements for laser-induced thermotherapy (diameter < 5 cm, number ≤ 5). The TACE protocol was performed with either mitomycin C alone (n = 53) or mitomycin C in combination with gemcitabine (n = 108).

RESULTS

In response to TACE overall, the mean reduction in diameter based on the longest diameter of the target lesions was 27%. The difference between diameter reduction in the mitomycin C group and that in the mitomycin C-gemcitabine group was not statistically significant (p = 0.65). The mean survival time of all patients was 32.5 months, calculation starting from the first TACE treatment. The mean local tumor control period calculated as of completion of therapy was 13 months, and the mean time to progression was 8 months. In the mitomycin-gemcitabine group, mean time to progression was 10.7 months, and in the mitomycin group it was 6.9 months (p = 0.5).

CONCLUSION

TACE can be used for sufficient downstaging of liver metastatic lesions of breast cancer to allow laser-induced thermotherapy. A combination of mitomycin C and gemcitabine seems to improve the reduction achieved with TACE.