The Impact of Locoregional Treatment on Survival in Patients With Metastatic Breast Cancer: A National Cancer Database Analysis |
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| Institution: | 1. Department of Radiation Oncology, Boston Medical Center, Boston, MA;2. Department of Hematology Oncology, Boston Medical Center, Boston, MA;3. Department of Surgery, Boston Medical Center, Boston, MA;4. Present affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA;1. Unità di Oncologia Chirurgica Ricostruttiva della Mammella, “Spedali Riuniti” di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia;2. Department of Surgery “P. Valdoni,” Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy;3. Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy;1. Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China;2. Department of Ultrasound, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, Henan, China;3. Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China;1. Vanderbilt University School of Medicine, Nashville, TN;2. Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN;3. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN;1. Department of Radiation Oncology, Institut du Cancer Courlancy, Reims, France;2. Department of Radiation Oncology, Institut du Cancer Montpellier, Montpellier, France;3. Department of Radiation Oncology, Oncopole, IUCT, Toulouse, France;4. Department of Surgical Oncology, Centre Oscar Lambret, Lille, France;5. Department of Surgical Oncology, Institut Bergonié, Bordeaux, France;6. Department of Radiation Oncology, Institut Sainte Catherine, Avignon, France;7. Department of Radiation Oncology, Institut Daniel Hollard, Grenoble, France;8. Department of Radiation Oncology, Centre René Huguenin, Saint Cloud, France;9. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France;10. Department of Medical Oncology, Hôpital Saint Louis, Paris, France;11. Sylia Stat, Bourg-la-Reine, France;12. Department of Radiation Oncology, Institut Curie, Paris, France;1. University of Michigan Medical School, Ann Arbor, MI;2. Department of Surgery, The University of Michigan, Ann Arbor, MI;1. Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey;2. Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey |
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| Abstract: | BackgroundAlthough systemic therapy is the standard treatment for metastatic breast cancer, the value of locoregional treatment (LRT) of the primary tumor and its impact on survival is controversial. This study evaluates survival outcomes in patients with metastatic breast cancer after receiving LRT (surgery and/or radiation therapy) of the primary tumor.Materials and MethodsThe National Cancer Database was used to identify 16,128 qualifying cases of metastatic breast cancer who received systemic therapy with or without LRT from 2004 to 2013. Treatment modality was divided into surgery (Sx), radiation therapy (RT), surgery followed by RT (Sx + RT), and no LRT. The median survival and 3-year actuarial survival rates (OS) were analyzed for each treatment group. On multivariate analyses, adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox regression modeling to adjust for patient and clinicopathologic characteristics.ResultsOverall, the median follow-up was 28.3 months, and the median survival for all patients was 37.2 months. With 9761 deaths reported, the estimated 3-year OS was 51.3%. The Sx + RT group (n = 2166) had the highest 3-year OS of 69.4%, followed by the Sx group (n = 4293) with 57.6%, the no LRT group (n = 8955) with 44.3%, and the RT group (n = 714) with 41.5% (P < .0001). On multivariate analysis, compared with the no LRT group, a decreased HR was noted in patients receiving Sx (adjusted HR, 0.68; 95% CI, 0.65-0.71; P < .0001) and Sx + RT (adjusted HR, 0.46; 95% CI, 0.43-0.49; P < .0001).ConclusionLRT, especially surgery followed by RT, in addition to systemic therapy, was associated with improved survival in patients with metastatic breast cancer. |
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| Keywords: | Local treatment Radiation therapy Stage IV breast cancer Surgery Overall survival |
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