Weykamp Fabian, König Laila, Seidensaal Katharina, Forster Tobias, Hoegen Philipp, Akbaba Sati, Mende Stephan, Welte Stefan E, Deutsch Thomas M, Schneeweiss Andreas, Debus Jürgen, Hörner-Rieber Juliane
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
Front Oncol. 2020 Jun 26;10:987. doi: 10.3389/fonc.2020.00987. eCollection 2020.
Oligometastatic disease (OMD) and oligoprogressive disease (OPD) describe tumor states with a limited metastasization. In contrast to other disease states, treatment of OMD or OPD has not yet become common for breast cancer. We sought to understand the outcomes and toxicities of this treatment paradigm. We retrospectively analyzed female breast cancer patients with OMD (≤3 metastases) or OPD (1 progressive lesion) who received stereotactic body radiotherapy (SBRT) for their respective extracranial metastatic lesions between 01/2002 and 07/2019. Survival analysis was performed using the Kaplan-Meier method with log-rank test being used for evaluation of significance. Cox regression was used to detect prognostic outcome factors. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE v. 5.0). Forty-six patients (70% OMD; 30% OPD) with 58 lesions met criteria for inclusion. The majority of treatments (34 out of 58; 58.6%) were delivered from 2017 to 2018. Treatment sites were bone, liver, lung [ = 19 (33%) for each site], and adrenal gland [ = 1 (1%)]. Median biologically effective dose (BED at α/β = 10) was 81.6 Gy (range: 45-112.5 Gy) and median planning target volume was 36.60 mL (range: 3.76-311.00 mL). At 2 years, local control (LC) was 89%, distant control (DC) was 44%, progression free survival (PFS) was 17% and overall survival (OS) was 62%. Multivariate analysis identified the diagnosis of a solitary metastasis as an independent prognostic factor for superior DC (HR = 0.186, CI [0.055; 0.626], = 0.007) and PFS (HR = 0.363, CI [0.152; 0.863], = 0.022). OS was independently inferior for patients treated at a higher age (HR = 5.788, CI [1.077; 31.119] = 0.041). Nine (15.5%) grade I° and one (1.7%) grade II° toxicities were recorded, with no grade III° or higher toxicities. Extracranial SBRT in breast cancer patients with OMD or OPD was well-tolerated with excellent LC. SBRT should especially be offered to younger OMD and OPD breast cancer patients with only one metastasis. The increase in utilization since 2017 points toward a growing acceptance of SBRT for OMD and OPD in breast cancer.
寡转移疾病（OMD）和寡进展性疾病（OPD）描述的是转移受限的肿瘤状态。与其他疾病状态不同，OMD或OPD的治疗在乳腺癌中尚未普遍应用。我们试图了解这种治疗模式的疗效和毒性。我们回顾性分析了2002年1月至2019年7月期间因各自的颅外转移病灶接受立体定向体部放疗（SBRT）的患有OMD（≤3处转移）或OPD（1处进展性病灶）的女性乳腺癌患者。使用Kaplan-Meier方法进行生存分析，并使用对数秩检验评估显著性。使用Cox回归检测预后结局因素。使用不良事件通用术语标准（CTCAE v. 5.0）评估毒性。46例患者（70%为OMD；30%为OPD）共58处病灶符合纳入标准。大多数治疗（58处中的34处；58.6%）在2017年至2018年进行。治疗部位为骨、肝、肺[每个部位均为19处（33%）]和肾上腺[1处（1%）]。中位生物等效剂量（α/β = 10时的BED）为81.6 Gy（范围：45 - 112.5 Gy），中位计划靶体积为36.60 mL（范围：3.76 - 311.00 mL）。2年时，局部控制（LC）率为89%，远处控制（DC）率为44%，无进展生存期（PFS）为17%，总生存期（OS）为62%。多因素分析确定孤立转移的诊断是DC（HR = 0.186，CI [0.055；0.626]，P = 0.007）和PFS（HR = 0.363，CI [0.152；0.863]，P = 0.022）较好的独立预后因素。年龄较大患者的OS独立较差（HR = 5.788，CI [1.077；31.119]，P = 0.041）。记录到9例（15.5%）I°级和1例（1.7%）II°级毒性反应，无III°级或更高级别的毒性反应。患有OMD或OPD的乳腺癌患者进行颅外SBRT耐受性良好，局部控制效果极佳。对于仅发生一处转移的年轻OMD和OPD乳腺癌患者，尤其应提供SBRT治疗。自2017年以来使用率的增加表明SBRT在乳腺癌OMD和OPD中的接受度不断提高。
