Scorsetti Marta, Franceschini Davide, De Rose Fiorenza, Comito Tiziana, Villa Elisa, Iftode Cristina, Navarria Pierina, D'Agostino Giuseppe Roberto, Masci Giovanna, Torrisi Rosalba, Testori Alberto, Tinterri Corrado, Santoro Armando
Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
Breast. 2016 Apr;26:11-7. doi: 10.1016/j.breast.2015.12.002. Epub 2016 Jan 3.
Multidisciplinary management of oligometastatic breast cancer with local therapy could improve disease control. The aim of our study is the assessment of safety and efficacy of Stereotactic Body Radiation Therapy (SBRT) in selected subset of patients.
Oligometastastic patients from breast cancer were treated with SBRT for 1-3 lung and liver lesions, in an observational study. Inclusion criteria were: age >18 years, ECOG 0-2, diagnosis of breast cancer, no extrapulmonary and/or extrahepatic disease, other metastatic sites stable or responding after chemotherapy were allowed, no life threatening conditions, less than 5 lung and liver lesions (with maximum diameter <5 cm), chemotherapy completed at least 3 weeks before treatment, written informed consent. Prescription dose ranged between 48 and 75 Gy in 3 or 4 consecutive fractions. Primary end-point was local control (LC). Secondary end-points were toxicity, overall survival (OS) and progression-free survival (PFS).
From April 2010 to June 2014, 33 patients for a total number of 43 lesions were irradiated. Median follow up was 24 months (range 3-59). Actuarial LC rates were 98% at 1 year and 90% at 2 and 3 years. Complete response, partial response and progressive disease were detected in 25 (53.2%), 16 (34%), and 6 (12.8%) lesions, respectively. Median OS was 48 months. Actuarial OS rates at 1 and 2 years were 93% and 66% respectively. Median PFS was 11 months, with a PFS rate at 1 and 2 years of 48% and 27%, respectively. At univariate analysis DFI >12 months, hormonal receptor positivity, medical therapies after SBRT showed a significant impact on OS. Treatment was well tolerated, with no G3-4 toxicities.
SBRT is a safe and feasible alternative treatment of liver and lung oligometastases from breast cancer, in selected patients not amenable to surgery, with good local control and survival rate.
采用局部治疗对寡转移性乳腺癌进行多学科管理可改善疾病控制。我们研究的目的是评估立体定向体部放射治疗（SBRT）在特定患者亚组中的安全性和有效性。
在一项观察性研究中，对患有乳腺癌的寡转移患者的1 - 3个肺和肝脏病灶进行SBRT治疗。纳入标准为：年龄>18岁，东部肿瘤协作组（ECOG）体能状态评分0 - 2，确诊为乳腺癌，无肺外和/或肝外疾病，允许其他转移部位在化疗后稳定或有反应，无危及生命的情况，肺和肝脏病灶少于5个（最大直径<5 cm），治疗前至少3周完成化疗，签署书面知情同意书。处方剂量在3或4个连续分次中为48至75 Gy。主要终点是局部控制（LC）。次要终点是毒性、总生存期（OS）和无进展生存期（PFS）。
从2010年4月至2014年6月，共对33例患者的43个病灶进行了照射。中位随访时间为24个月（范围3 - 59个月）。1年、2年和3年的精算局部控制率分别为98%、90%。分别在25个（53.2%）、16个（34%）和6个（12.8%）病灶中检测到完全缓解、部分缓解和疾病进展。中位总生存期为48个月。1年和2年的精算总生存率分别为93%和66%。中位无进展生存期为11个月，1年和2年的无进展生存率分别为48%和27%。单因素分析显示，无病生存期（DFI）>12个月、激素受体阳性、SBRT后的药物治疗对总生存期有显著影响。治疗耐受性良好，无3 - 4级毒性反应。
对于无法进行手术的特定患者，SBRT是治疗乳腺癌肝和肺寡转移的一种安全可行的替代治疗方法，具有良好的局部控制率和生存率。
