Medical Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Radiation Oncology, American University of Beirut, Beirut, Lebanon.
Int J Cancer. 2021 Oct 15;149(8):1520-1528. doi: 10.1002/ijc.33693. Epub 2021 Jun 8.
Patients with metastatic breast cancer are usually considered incurable. Recent advances have resulted in significant improvements in survival for patients with metastatic breast cancer. Due to the lack of randomised trials and heterogeneous disease biology, treatment decisions for patients with oligometastatic breast cancer vary widely. Some patients are treated similar to those with widespread disease while others are treated more aggressively. We conducted a review of the evidence for treatment options in oligometastatic breast cancer and consulted ClinicalTrials.gov to explore currently accruing or studies in development aimed at investigating oligometastatic disease in breast cancer. Surgery to the primary tumour in patients with metastatic breast cancer has failed to show any advantage over systemic therapy. However, there may be a benefit in women with controlled systemic disease who are hormone receptor positive with bone-predominant metastasis. Stereotactic radiotherapy has gained increased interest in this setting due to its excellent efficacy and lower rates of associated toxicity. A significant challenge remains in identifying the patient population who would benefit from such an approach, and to do so, we need to understand the distinct biology of oligometastatic breast cancer. Unique miRNA expression and low levels of tumour infiltrating lymphocytes in the immune micro-environment have been described in tumour tissues in patients with oligometastatic breast cancer. There is ongoing research aimed to better characterise these tumours, thus, allowing the selection of patients who would truly benefit from multi-modality treatment in an attempt for long-term survival and cure.
转移性乳腺癌患者通常被认为是无法治愈的。最近的进展显著提高了转移性乳腺癌患者的生存率。由于缺乏随机试验和异质的疾病生物学，寡转移性乳腺癌患者的治疗决策差异很大。一些患者的治疗方法与广泛疾病患者相似，而另一些患者的治疗方法则更为激进。我们对寡转移性乳腺癌的治疗选择进行了文献回顾，并查阅了 ClinicalTrials.gov，以探讨目前正在进行或正在开发的旨在研究乳腺癌寡转移疾病的研究。转移性乳腺癌患者的原发肿瘤手术未能显示出优于全身治疗的优势。然而，对于那些全身疾病得到控制且激素受体阳性、骨转移为主的女性，可能会有获益。立体定向放疗由于其优异的疗效和较低的相关毒性，在这种情况下引起了越来越多的关注。目前仍面临一个重大挑战，即如何确定哪些患者将从这种治疗方法中获益，为了做到这一点，我们需要了解寡转移性乳腺癌的独特生物学特性。寡转移性乳腺癌患者的肿瘤组织中描述了独特的 miRNA 表达和免疫微环境中肿瘤浸润淋巴细胞水平较低。目前正在进行旨在更好地描述这些肿瘤的研究，从而选择真正受益于多模式治疗以试图长期生存和治愈的患者。
