Locoregional Treatment of the Primary Tumor in Patients With De Novo Stage IV Breast Cancer: A Radiation Oncologist's Perspective

Seo Hee Choi, Jun Won Kim, Jinhyun Choi, Joohyuk Sohn, Seung Il Kim, Seho Park, Hyung Seok Park, Joon Jeong, Chang Ok Suh, Ki Chang Keum, Yong Bae Kim, Ik Jae Lee

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

De novo stage IV breast cancer, a disease that is metastatic from the start, is relatively uncommon. The survival rate varies considerably, but most patients receive only systemic therapy. The efficacy of locoregional treatment like surgery and/or radiotherapy is controversial. We retrospectively assessed the benefits of locoregional treatment of the primary site in de novo stage IV breast cancer. Background: The aim of this study was to assess the outcomes of patients with de novo stage IV breast cancer after locoregional treatment (LRT) of primary site. Patients and Methods: We studied 245 patients diagnosed with de novo stage IV breast cancer. LRT of the primary tumor (+ systemic therapy) was performed in 82 (34%) patients (surgery, 27; surgery + radiotherapy (RT), 46; and RT, 9). Among those undergoing surgery, 64 (88%) patients underwent mastectomy, and 9 (12%) patients underwent breast-conserving surgery (BCS). Local recurrence-free survival (LRFS) and overall survival (OS) were investigated, and propensity score matching was used to balance patient distributions. Results: The 5-year LRFS and OS rates were 27% and 50%, respectively. Advanced T stage (T4), liver or brain metastasis, ≥ 5 metastatic sites, and absence of hormone therapy were significant adverse factors for LRFS, whereas T4 stage and absence of hormone therapy were significant for OS. The LRT group demonstrated significantly more favorable outcomes (5-year LRFS, 61%; 5-year OS, 71%), especially after surgery. After matching, survival rates remained significantly higher for patients who received LRT (5-year LRFS, 62% vs. 20%; P <.001; 5-year OS, 73% vs. 45%; P =.02). BCS + RT was superior to mastectomy ± RT, which can be attributed to more patients with a low tumor burden undergoing BCS + RT. Outcomes were better with post-mastectomy RT in selected patients (≥ N2, ≥ T3, or T2N1). Conclusions: Upfront LRT including RT is an important option together with systemic therapies for de novo stage IV breast cancer.

Original languageEnglish
Pages (from-to)e167-e178
JournalClinical Breast Cancer
Volume18
Issue number2
DOIs
Publication statusPublished - 2018 Apr

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Breast Neoplasms
Radiotherapy
Survival
Neoplasms
Segmental Mastectomy
Mastectomy
Recurrence
Therapeutics
Survival Rate
Radiation Oncologists
Hormones
Propensity Score
Tumor Burden
Neoplasm Metastasis
Liver
Brain

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Choi, Seo Hee ; Kim, Jun Won ; Choi, Jinhyun ; Sohn, Joohyuk ; Kim, Seung Il ; Park, Seho ; Park, Hyung Seok ; Jeong, Joon ; Suh, Chang Ok ; Keum, Ki Chang ; Kim, Yong Bae ; Lee, Ik Jae. / Locoregional Treatment of the Primary Tumor in Patients With De Novo Stage IV Breast Cancer : A Radiation Oncologist's Perspective. In: Clinical Breast Cancer. 2018 ; Vol. 18, No. 2. pp. e167-e178.
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title = "Locoregional Treatment of the Primary Tumor in Patients With De Novo Stage IV Breast Cancer: A Radiation Oncologist's Perspective",
abstract = "De novo stage IV breast cancer, a disease that is metastatic from the start, is relatively uncommon. The survival rate varies considerably, but most patients receive only systemic therapy. The efficacy of locoregional treatment like surgery and/or radiotherapy is controversial. We retrospectively assessed the benefits of locoregional treatment of the primary site in de novo stage IV breast cancer. Background: The aim of this study was to assess the outcomes of patients with de novo stage IV breast cancer after locoregional treatment (LRT) of primary site. Patients and Methods: We studied 245 patients diagnosed with de novo stage IV breast cancer. LRT of the primary tumor (+ systemic therapy) was performed in 82 (34{\%}) patients (surgery, 27; surgery + radiotherapy (RT), 46; and RT, 9). Among those undergoing surgery, 64 (88{\%}) patients underwent mastectomy, and 9 (12{\%}) patients underwent breast-conserving surgery (BCS). Local recurrence-free survival (LRFS) and overall survival (OS) were investigated, and propensity score matching was used to balance patient distributions. Results: The 5-year LRFS and OS rates were 27{\%} and 50{\%}, respectively. Advanced T stage (T4), liver or brain metastasis, ≥ 5 metastatic sites, and absence of hormone therapy were significant adverse factors for LRFS, whereas T4 stage and absence of hormone therapy were significant for OS. The LRT group demonstrated significantly more favorable outcomes (5-year LRFS, 61{\%}; 5-year OS, 71{\%}), especially after surgery. After matching, survival rates remained significantly higher for patients who received LRT (5-year LRFS, 62{\%} vs. 20{\%}; P <.001; 5-year OS, 73{\%} vs. 45{\%}; P =.02). BCS + RT was superior to mastectomy ± RT, which can be attributed to more patients with a low tumor burden undergoing BCS + RT. Outcomes were better with post-mastectomy RT in selected patients (≥ N2, ≥ T3, or T2N1). Conclusions: Upfront LRT including RT is an important option together with systemic therapies for de novo stage IV breast cancer.",
author = "Choi, {Seo Hee} and Kim, {Jun Won} and Jinhyun Choi and Joohyuk Sohn and Kim, {Seung Il} and Seho Park and Park, {Hyung Seok} and Joon Jeong and Suh, {Chang Ok} and Keum, {Ki Chang} and Kim, {Yong Bae} and Lee, {Ik Jae}",
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Locoregional Treatment of the Primary Tumor in Patients With De Novo Stage IV Breast Cancer : A Radiation Oncologist's Perspective. / Choi, Seo Hee; Kim, Jun Won; Choi, Jinhyun; Sohn, Joohyuk; Kim, Seung Il; Park, Seho; Park, Hyung Seok; Jeong, Joon; Suh, Chang Ok; Keum, Ki Chang; Kim, Yong Bae; Lee, Ik Jae.

In: Clinical Breast Cancer, Vol. 18, No. 2, 04.2018, p. e167-e178.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Locoregional Treatment of the Primary Tumor in Patients With De Novo Stage IV Breast Cancer

T2 - A Radiation Oncologist's Perspective

AU - Choi, Seo Hee

AU - Kim, Jun Won

AU - Choi, Jinhyun

AU - Sohn, Joohyuk

AU - Kim, Seung Il

AU - Park, Seho

AU - Park, Hyung Seok

AU - Jeong, Joon

AU - Suh, Chang Ok

AU - Keum, Ki Chang

AU - Kim, Yong Bae

AU - Lee, Ik Jae

PY - 2018/4

Y1 - 2018/4

N2 - De novo stage IV breast cancer, a disease that is metastatic from the start, is relatively uncommon. The survival rate varies considerably, but most patients receive only systemic therapy. The efficacy of locoregional treatment like surgery and/or radiotherapy is controversial. We retrospectively assessed the benefits of locoregional treatment of the primary site in de novo stage IV breast cancer. Background: The aim of this study was to assess the outcomes of patients with de novo stage IV breast cancer after locoregional treatment (LRT) of primary site. Patients and Methods: We studied 245 patients diagnosed with de novo stage IV breast cancer. LRT of the primary tumor (+ systemic therapy) was performed in 82 (34%) patients (surgery, 27; surgery + radiotherapy (RT), 46; and RT, 9). Among those undergoing surgery, 64 (88%) patients underwent mastectomy, and 9 (12%) patients underwent breast-conserving surgery (BCS). Local recurrence-free survival (LRFS) and overall survival (OS) were investigated, and propensity score matching was used to balance patient distributions. Results: The 5-year LRFS and OS rates were 27% and 50%, respectively. Advanced T stage (T4), liver or brain metastasis, ≥ 5 metastatic sites, and absence of hormone therapy were significant adverse factors for LRFS, whereas T4 stage and absence of hormone therapy were significant for OS. The LRT group demonstrated significantly more favorable outcomes (5-year LRFS, 61%; 5-year OS, 71%), especially after surgery. After matching, survival rates remained significantly higher for patients who received LRT (5-year LRFS, 62% vs. 20%; P <.001; 5-year OS, 73% vs. 45%; P =.02). BCS + RT was superior to mastectomy ± RT, which can be attributed to more patients with a low tumor burden undergoing BCS + RT. Outcomes were better with post-mastectomy RT in selected patients (≥ N2, ≥ T3, or T2N1). Conclusions: Upfront LRT including RT is an important option together with systemic therapies for de novo stage IV breast cancer.

AB - De novo stage IV breast cancer, a disease that is metastatic from the start, is relatively uncommon. The survival rate varies considerably, but most patients receive only systemic therapy. The efficacy of locoregional treatment like surgery and/or radiotherapy is controversial. We retrospectively assessed the benefits of locoregional treatment of the primary site in de novo stage IV breast cancer. Background: The aim of this study was to assess the outcomes of patients with de novo stage IV breast cancer after locoregional treatment (LRT) of primary site. Patients and Methods: We studied 245 patients diagnosed with de novo stage IV breast cancer. LRT of the primary tumor (+ systemic therapy) was performed in 82 (34%) patients (surgery, 27; surgery + radiotherapy (RT), 46; and RT, 9). Among those undergoing surgery, 64 (88%) patients underwent mastectomy, and 9 (12%) patients underwent breast-conserving surgery (BCS). Local recurrence-free survival (LRFS) and overall survival (OS) were investigated, and propensity score matching was used to balance patient distributions. Results: The 5-year LRFS and OS rates were 27% and 50%, respectively. Advanced T stage (T4), liver or brain metastasis, ≥ 5 metastatic sites, and absence of hormone therapy were significant adverse factors for LRFS, whereas T4 stage and absence of hormone therapy were significant for OS. The LRT group demonstrated significantly more favorable outcomes (5-year LRFS, 61%; 5-year OS, 71%), especially after surgery. After matching, survival rates remained significantly higher for patients who received LRT (5-year LRFS, 62% vs. 20%; P <.001; 5-year OS, 73% vs. 45%; P =.02). BCS + RT was superior to mastectomy ± RT, which can be attributed to more patients with a low tumor burden undergoing BCS + RT. Outcomes were better with post-mastectomy RT in selected patients (≥ N2, ≥ T3, or T2N1). Conclusions: Upfront LRT including RT is an important option together with systemic therapies for de novo stage IV breast cancer.

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