scholarly journals The Role of Postoperative Radiotherapy After Primary Tumor Resection in Patients With De Novo Stage Iv Breast Cancer

2020 ◽  
Author(s):  
Yeon Joo Kim ◽  
Su Ssan Kim ◽  
Seung Do Ahn ◽  
Jinhong Jung ◽  
Sei-Hyun Ahn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
De Novo ◽  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Stage Iv ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
Free Survival ◽  
Stage Iv Breast Cancer

Abstract Background: To investigate the role of postoperative radiotherapy (PORT) in stage IV breast cancer patients who underwent planned primary tumor resection (PTR).Methods: This study enrolled 112 patients diagnosed with de novo stage IV breast cancer who were treated with potentially curative PTR with or without PORT. The primary outcome was overall survival (OS), and the secondary outcomes were locoregional recurrence-free survival (LRRFS) and distant progression-free survival (DPFS).Results: At a median follow-up of 48.9 months (range, 3.5–183.4 months), the median OS was 54.9 months (range, 5.3–185.9 months) with a 5 year OS rate of 59.6%. Luminal A or B type tumors and PORT were significantly predictive of longer OS. The 5 year LRRFS and DMFS rates were 79.0% and 34.3%, respectively. PORT was the only significant predictor of LRRFS (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.15–0.86; p = 0.021). A comparison of patients who did and did not receive PORT showed that patients with disseminated metastasis more likely did not receive PORT and were excluded from the analysis. Multivariate analysis showed that PORT was significantly predictive of LRRFS (HR, 0.31; 95% CI, 0.11–0.91; p = 0.033) but not of OS. Conclusions: De novo stage IV breast cancer patients who received planned PTR showed favorable survival outcomes compared with historical cohorts. PTR may be predictive of a good prognosis, especially in patients with luminal A or B type tumors. PORT was significantly predictive of LRRFS, suggesting that patients may benefit from this treatment.Trial registration: The present study was not registered due to its retrospective nature.

Primary tumor resection in de novo stage IV breast cancer patients

2020 ◽  
Vol 26 (7) ◽  
pp. 1366-1369
Author(s):  
Craig Joshua Follette ◽  
Clare Humphrey ◽  
Amanda Amin ◽  
Christa Balanoff ◽  
Jamie Wagner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Primary Tumor ◽  
De Novo ◽  
Tumor Resection ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Breast Cancer Patients ◽  
Stage Iv Breast Cancer

Relationship between tumor size and metastatic site in patients with stage IV breast cancer: A large SEER-based study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13065-e13065
Author(s):  
Qian Dong ◽  
Mi Zhang ◽  
Da Jiang
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Tumor Size ◽  
Stage Iv ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
Chi Square ◽  
Metastatic Site ◽  
Luminal B ◽  
Stage Iv Breast Cancer

e13065 Background: To analyze the correlation between tumor size and metastatic site in first-diagnosed stage IV breast cancer patients. Methods: Stage IV breast cancer patients diagnosed from 2010 to 2015 were screened by the Surveillance, Epidemiology, and End Results (SEER) database. The characteristics of clinical variables were represented by a frequency table, and the Chi-square test was used for comparison. At the same time, the Chi-square test was used to analyze the relationship between tumor size and organ metastasis. Correlation between tumor size and the prognosis of patients was contributed by KM curve and Log-rank test. Results: Regardless of tumor size, the proportion of bone metastasis was higher and brain metastasis was lower in breast cancer patients. There were significant differences in the site of metastases based on different subtype. Luminal A and Luminal B breast cancer had the highest proportion of bone metastases; brain metastasis accounted for the highest proportion in triple-negative breast cancer (TNBC); while the incidence of liver metastasis was the highest in Her-2(+) breast cancer. At the same time, the results indicated that Luminal A breast cancer with a tumor size > 5 cm was more likely to develop multi-site metastasis and lung metastasis, while Luminal B breast cancer with a tumor size ≤ 5 cm was more likely to develop liver metastasis. The results also revealed that TNBC patients with a tumor size of 0 - 2cm were more likely to develop bone metastasis than those with a tumor size > 5 cm, and the incidence of lung metastasis in triple-negative patients showed an increasing trend with the increase of tumor size. Conclusions: Based on subtype, we found that there was a significant difference between tumor size and metastatic site in patients with stage IV breast cancer, and the difference was statistically significant. This study provided evidence-based basis for decision-making of stage IV breast cancer treatment.

scholarly journals Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2103
Author(s):  
Byoung Hyuck Kim ◽  
Suzy Kim ◽  
Young Il Kim ◽  
Ji Hyun Chang ◽  
Ki-Tae Hwang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
De Novo ◽  
Postoperative Radiotherapy ◽  
Stage Iv ◽  
Receptor Expression ◽  
Web Based ◽  
Stage Iv Breast Cancer ◽  
The Individual

Purpose: Locoregional treatment has been increasingly adopted for metastatic breast cancer at presentation. This study aims to develop an individualized calculator to predict the benefit of postoperative radiotherapy (PORT) for patients with surgically resected de novo stage IV breast cancer. Methods and Materials: We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with stage IV breast cancer between 2010 and 2014. After applying exclusion criteria, a total of 4473 patients were included in the analysis. Propensity score matching was used to balance the individual characteristics of the patients. After identifying the significant prognosticators, a nomogram was developed using multivariate regression models and internally validated. A web-based calculator was then constructed using a fitted survival prediction model. Results: With a median follow-up of 34 months, the three-year overall survival (OS) rates were 54.1% in the surgery alone group and 63.5% in the surgery + PORT group (p < 0.001). The survival benefit of PORT was maintained after propensity score matching (p < 0.001). Interaction testing of the prognostic variables found significant interactions between PORT and the presence of brain metastasis (p = 0.001), and between PORT and hormonal receptor expression (p = 0.018). After reviewing the performance of various models, a log-normal distributed survival model was adopted, with a C-index of 0.695. A calibration plot verified that the predicted survival rates were strongly correlated with the actual OS rates. A web-based survival calculator was constructed to provide individualized estimates of survival according to PORT. Conclusion: PORT significantly improved OS rates, though the individual benefit was affected by a number of factors. We successfully developed a nomogram and web-based calculator that predicted the prognosis according to PORT in patients with surgically resected de novo stage IV breast cancer. These tools are expected to be useful in clinical practice and in the design of related trials.

A randomized controlled trial comparing primary tumor resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (JCOG1017 PRIM-BC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS588-TPS588 ◽  
Author(s):  
Tadahiko Shien ◽  
Tomonori Mizutani ◽  
Kiyo Tanaka ◽  
Takayuki Kinoshita ◽  
Fumikata Hara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Primary Tumor Resection ◽  
Her2 Status ◽  
Free Survival ◽  
Stage Iv Breast Cancer

TPS588 Background: The possibility of improving the survival of stage IV breast cancer patients by primary tumor resection (PTR) has been reported by several retrospective studies; however, these studies essentially suffer from biases such as arbitrary patient selection, diverse timing of surgery or various regimens of systemic therapy. Five prospective randomized trials including our trial have evaluated the efficacy of PTR for them. Two have reported final results, but those results were inconsistent. Therefore, this subject still remains a hotly debated topic at major breast conferences. Methods: Our trial is being conducted to confirm the superiority of PTR plus systemic therapy over systemic therapy alone in stage IV pts who are sensitive to primary systemic therapy (PST) in this study. The inclusion criteria are untreated pts with histologically confirmed invasive breast cancer with one or more measurable distant metastatic lesions diagnosed by radiological examination.All pts receive PST according to the ER and HER2 status of the primary breast cancer after the first registration. After three months, the pts who are sensitive to PST are randomized to the PTR plus systemic therapy arm or the systemic therapy alone arm. After randomization and surgery in the former arm, or after randomization in the latter arm, the same systemic therapies are continued until progression of diseases and next appropriate regimens are started after that. The primary endpoint is the overall survival, and the secondary endpoints are proportion of pts without tumor progression at the metastatic sites, yearly local recurrence-free survival, proportion of local ulcer/local bleeding, yearly primary tumor resection-free survival, adverse events (AEs) of chemotherapy, operative morbidity, and serious AEs. Sample size for randomized pts was determined to attain at least 80% of power to detect a 6 months difference with one-sided alpha of 0.05.The pts accrual was started in May 2011. Enrollment of 410 pts for randomization is planned over a 7-year accrual period. 307 pts have been randomized until Jan 2017. This trial was registered at UMIN-CTR[umin.ac.jp/ctr/] as UMIN000005586. Clinical trial information: UMIN000005586.

scholarly journals Role of Locoregional Treatment in De Novo Stage IV Breast Cancer

2020 ◽  
Vol 14 ◽  
pp. 117955492094244
Author(s):  
Joanna S Lee ◽  
Osman Toktas ◽  
Atilla Soran
Keyword(s):  
Breast Cancer ◽  
United States ◽  
De Novo ◽  
Stage Iv ◽  
The United States ◽  
Comprehensive Overview ◽  
Primary Systemic Therapy ◽  
Locoregional Treatment ◽  
Stage Iv Breast Cancer

It is estimated that approximately 154000 women in the United States have stage IV breast cancer (BC). A subset of this group has metastatic disease at presentation, known as de novo stage IV disease. De novo stage IV BC accounts for approximately 6% of all BC diagnoses in the United States. Traditionally, stage IV BC patients are treated with primary systemic therapy with a palliative intent reserving possible locoregional treatment (LRT) as last resort. There has been a lot of interest in the role of LRT in de novo stage IV BC for the past decade with mixed conclusions. Although this review is not intended to be a comprehensive overview of all literature regarding this topic to date, we will review the recent findings in literature focusing on the studies with larger sample sizes to investigate the role of LRT in de novo stage IV BC.

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