Steinauer Kirsten, Huang Dorothy Jane, Eppenberger-Castori Serenella, Amann Esther, Güth Uwe
Cantonal Hospital Winterthur, Department of Radiation Therapy and Radiation Oncology, Brauerstrasse 15, CH-8401 Winterthur, Switzerland; Breast Center "SenoSuisse", Brauerstrasse 15, CH-8401 Winterthur, Switzerland.
University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland.
J Bone Oncol. 2014 May 20;3(2):54-60. doi: 10.1016/j.jbo.2014.05.001. eCollection 2014 May.
The study evaluates the frequency of and indications for bone-metastases (BM)-related surgery and/or radiotherapy in the palliative breast cancer (BC) situation and analyzes in which phase of the palliative disease course surgery and/or radiotherapy was applied.
340 patients who developed distant metastatic disease (DMD) and died (i.e. patients with completed disease courses) were analyzed.
From the entire study cohort, 237 patients (69.7%) were diagnosed with BM. Out of these, 116 patients (48.9%) received BM-related radiotherapy and/or surgery during the palliative situation.
108 patients (45.6%) received 161 series (range: 1-5) with 217 volumina (range: 1-8) on 300 osseous sites. At 75.3% of the radiated sites, the spine was the most frequent radiated location. Eighty-eight series (54.7%) were performed in the first third of the metastatic disease survival (MDS) period. The median survival after radiotherapy was 14 months (range: 0.2-121 months).
In 37 patients (15.6%), 50 procedures (range: 1-4) were necessary to stabilize BM. The femur predominated with 56.0% of the procedures. Twenty procedures (40.0%) were performed in the first third of survival follow-up. The median survival after surgery was 13.5 months (range: 0.5-49 months). BC patients with BM had a significantly improved MDS when radiotherapy and/or surgery for skeletal metastases was embedded in the palliative approach (27.5 months vs. 19.5 months, p<0.001). From the 118 patients who had a MDS of ≥24 months, the majority (54.2%) had BM-related radiotherapy and/or surgery during the palliative course.
Metastatic BC has become increasingly viewed as a chronic disease process. In a general palliative therapy approach, which allows for treatment according to the principles of a chronic disease, non-systemic therapy for BM, in particular radiotherapy, has a clearly established role in the therapy concept.
本研究评估了姑息性乳腺癌（BC）患者中骨转移（BM）相关手术和/或放疗的频率及适应证，并分析了手术和/或放疗在姑息性疾病进程的哪个阶段应用。
对340例发生远处转移性疾病（DMD）并死亡（即疾病进程结束的患者）进行了分析。
在整个研究队列中，237例患者（69.7%）被诊断为骨转移。其中，116例患者（48.9%）在姑息治疗期间接受了与骨转移相关的放疗和/或手术。
108例患者（45.6%）接受了161个疗程（范围：1 - 5个），共217个靶区（范围：1 - 8个），涉及300个骨部位。在75.3%的放疗部位中，脊柱是最常见的放疗部位。88个疗程（54.7%）在转移性疾病生存期（MDS）的前三分之一阶段进行。放疗后的中位生存期为14个月（范围：0.2 - 121个月）。
37例患者（15.6%）进行了50次手术（范围：1 - 4次）以稳定骨转移。其中股骨手术占比56.0%。20次手术（40.0%）在生存期随访的前三分之一阶段进行。手术后的中位生存期为13.5个月（范围：0.5 - 49个月）。当针对骨转移的放疗和/或手术纳入姑息治疗方案时，骨转移的BC患者的MDS有显著改善（27.5个月对19.5个月，p<0.001）。在118例MDS≥24个月的患者中，大多数（54.2%）在姑息治疗过程中接受了与骨转移相关的放疗和/或手术。
转移性BC越来越被视为一种慢性疾病过程。在允许按照慢性病原则进行治疗的一般姑息治疗方法中，针对骨转移的非全身治疗，尤其是放疗，在治疗理念中具有明确确立的作用。
