Radical radiation therapy for oligometastatic breast cancer: Results of a prospective phase II trial

Marco Trovo, Carlo Furlan, Jerry Polesel, Francesco Fiorica, Stefano Arcangeli, Niccolò Giaj-Levra, Filippo Alongi, Alessandro Del Conte, Loredana Militello, Elena Muraro, Debora Martorelli, Simon Spazzapan, Massimiliano Berretta

Research output: Contribution to journalArticle

Abstract

Background and purpose: We conducted a prospective phase II multicentric trial to determine if radical radiation therapy to all metastatic sites might improve the progression-free survival (PFS) in oligometastatic breast cancer patients. Secondary endpoints were local control (LC), overall survival (OS) and toxicity. Methods and materials: Inclusion criteria were the following: oligometastatic breast cancer with ≤5 metastatic sites, FDG-PET/CT staging, no brain metastases, primary tumor controlled. Radiotherapy could be delivered using stereotactic body radiotherapy (SBRT) technique or fractionated intensity modulated radiotherapy (IMRT). SBRT consisted of 30-45. Gy in 3 fractions, while IMRT was delivered to a total dose of 60. Gy in 25 fractions. We hypothesized that radical radiation therapy could increase the PFS from 30% (according to the published literature) to 50% at two years. Results: 54 Patients with 92 metastatic lesions were enrolled. Forty-four were treated with SBRT, and 10 with IMRT. Forty-eight (89%) patients received a form of systemic therapy concomitantly to radiation therapy. Sites of metastatic disease were the following: bones 60 lesions, lymph nodes 23 lesions, lung 4 lesions, liver 5 lesions. After a median follow-up of 30. months (range, 6-55. months), 1- and 2-year PFS was 75% and 53%, respectively. Two-year LC and OS were 97% and 95%, respectively. Radiation therapy was well tolerated, and no Grade ≥3 toxicity was documented. Grade 2 toxicity were pain and fatigue in 2 cases. Conclusions: Patients with oligometastatic breast cancer treated with radical radiotherapy to all metastatic sites may achieve long-term progression-free survival, without significant treatment-related toxicity. While waiting for data from randomized trials, the use of radical radiation therapy to all metastatic sites in patients with oligometastatic breast cancer should be considered a valuable option, and its recommendation should be individualized.

Original languageEnglish
JournalRadiotherapy and Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2017

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Radiotherapy
Breast Neoplasms
Intensity-Modulated Radiotherapy
Disease-Free Survival
Radiosurgery
Survival
Brain Neoplasms
Fatigue
Lymph Nodes
Neoplasm Metastasis
Bone and Bones
Pain
Lung
Liver
Therapeutics

Keywords

  • Breast cancer
  • Oligometastases
  • SBRT

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Radical radiation therapy for oligometastatic breast cancer : Results of a prospective phase II trial. / Trovo, Marco; Furlan, Carlo; Polesel, Jerry; Fiorica, Francesco; Arcangeli, Stefano; Giaj-Levra, Niccolò; Alongi, Filippo; Del Conte, Alessandro; Militello, Loredana; Muraro, Elena; Martorelli, Debora; Spazzapan, Simon; Berretta, Massimiliano.

In: Radiotherapy and Oncology, 01.01.2017.

Research output: Contribution to journalArticle

Trovo, Marco ; Furlan, Carlo ; Polesel, Jerry ; Fiorica, Francesco ; Arcangeli, Stefano ; Giaj-Levra, Niccolò ; Alongi, Filippo ; Del Conte, Alessandro ; Militello, Loredana ; Muraro, Elena ; Martorelli, Debora ; Spazzapan, Simon ; Berretta, Massimiliano. / Radical radiation therapy for oligometastatic breast cancer : Results of a prospective phase II trial. In: Radiotherapy and Oncology. 2017.
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abstract = "Background and purpose: We conducted a prospective phase II multicentric trial to determine if radical radiation therapy to all metastatic sites might improve the progression-free survival (PFS) in oligometastatic breast cancer patients. Secondary endpoints were local control (LC), overall survival (OS) and toxicity. Methods and materials: Inclusion criteria were the following: oligometastatic breast cancer with ≤5 metastatic sites, FDG-PET/CT staging, no brain metastases, primary tumor controlled. Radiotherapy could be delivered using stereotactic body radiotherapy (SBRT) technique or fractionated intensity modulated radiotherapy (IMRT). SBRT consisted of 30-45. Gy in 3 fractions, while IMRT was delivered to a total dose of 60. Gy in 25 fractions. We hypothesized that radical radiation therapy could increase the PFS from 30{\%} (according to the published literature) to 50{\%} at two years. Results: 54 Patients with 92 metastatic lesions were enrolled. Forty-four were treated with SBRT, and 10 with IMRT. Forty-eight (89{\%}) patients received a form of systemic therapy concomitantly to radiation therapy. Sites of metastatic disease were the following: bones 60 lesions, lymph nodes 23 lesions, lung 4 lesions, liver 5 lesions. After a median follow-up of 30. months (range, 6-55. months), 1- and 2-year PFS was 75{\%} and 53{\%}, respectively. Two-year LC and OS were 97{\%} and 95{\%}, respectively. Radiation therapy was well tolerated, and no Grade ≥3 toxicity was documented. Grade 2 toxicity were pain and fatigue in 2 cases. Conclusions: Patients with oligometastatic breast cancer treated with radical radiotherapy to all metastatic sites may achieve long-term progression-free survival, without significant treatment-related toxicity. While waiting for data from randomized trials, the use of radical radiation therapy to all metastatic sites in patients with oligometastatic breast cancer should be considered a valuable option, and its recommendation should be individualized.",
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AU - Trovo, Marco

AU - Furlan, Carlo

AU - Polesel, Jerry

AU - Fiorica, Francesco

AU - Arcangeli, Stefano

AU - Giaj-Levra, Niccolò

AU - Alongi, Filippo

AU - Del Conte, Alessandro

AU - Militello, Loredana

AU - Muraro, Elena

AU - Martorelli, Debora

AU - Spazzapan, Simon

AU - Berretta, Massimiliano

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N2 - Background and purpose: We conducted a prospective phase II multicentric trial to determine if radical radiation therapy to all metastatic sites might improve the progression-free survival (PFS) in oligometastatic breast cancer patients. Secondary endpoints were local control (LC), overall survival (OS) and toxicity. Methods and materials: Inclusion criteria were the following: oligometastatic breast cancer with ≤5 metastatic sites, FDG-PET/CT staging, no brain metastases, primary tumor controlled. Radiotherapy could be delivered using stereotactic body radiotherapy (SBRT) technique or fractionated intensity modulated radiotherapy (IMRT). SBRT consisted of 30-45. Gy in 3 fractions, while IMRT was delivered to a total dose of 60. Gy in 25 fractions. We hypothesized that radical radiation therapy could increase the PFS from 30% (according to the published literature) to 50% at two years. Results: 54 Patients with 92 metastatic lesions were enrolled. Forty-four were treated with SBRT, and 10 with IMRT. Forty-eight (89%) patients received a form of systemic therapy concomitantly to radiation therapy. Sites of metastatic disease were the following: bones 60 lesions, lymph nodes 23 lesions, lung 4 lesions, liver 5 lesions. After a median follow-up of 30. months (range, 6-55. months), 1- and 2-year PFS was 75% and 53%, respectively. Two-year LC and OS were 97% and 95%, respectively. Radiation therapy was well tolerated, and no Grade ≥3 toxicity was documented. Grade 2 toxicity were pain and fatigue in 2 cases. Conclusions: Patients with oligometastatic breast cancer treated with radical radiotherapy to all metastatic sites may achieve long-term progression-free survival, without significant treatment-related toxicity. While waiting for data from randomized trials, the use of radical radiation therapy to all metastatic sites in patients with oligometastatic breast cancer should be considered a valuable option, and its recommendation should be individualized.

AB - Background and purpose: We conducted a prospective phase II multicentric trial to determine if radical radiation therapy to all metastatic sites might improve the progression-free survival (PFS) in oligometastatic breast cancer patients. Secondary endpoints were local control (LC), overall survival (OS) and toxicity. Methods and materials: Inclusion criteria were the following: oligometastatic breast cancer with ≤5 metastatic sites, FDG-PET/CT staging, no brain metastases, primary tumor controlled. Radiotherapy could be delivered using stereotactic body radiotherapy (SBRT) technique or fractionated intensity modulated radiotherapy (IMRT). SBRT consisted of 30-45. Gy in 3 fractions, while IMRT was delivered to a total dose of 60. Gy in 25 fractions. We hypothesized that radical radiation therapy could increase the PFS from 30% (according to the published literature) to 50% at two years. Results: 54 Patients with 92 metastatic lesions were enrolled. Forty-four were treated with SBRT, and 10 with IMRT. Forty-eight (89%) patients received a form of systemic therapy concomitantly to radiation therapy. Sites of metastatic disease were the following: bones 60 lesions, lymph nodes 23 lesions, lung 4 lesions, liver 5 lesions. After a median follow-up of 30. months (range, 6-55. months), 1- and 2-year PFS was 75% and 53%, respectively. Two-year LC and OS were 97% and 95%, respectively. Radiation therapy was well tolerated, and no Grade ≥3 toxicity was documented. Grade 2 toxicity were pain and fatigue in 2 cases. Conclusions: Patients with oligometastatic breast cancer treated with radical radiotherapy to all metastatic sites may achieve long-term progression-free survival, without significant treatment-related toxicity. While waiting for data from randomized trials, the use of radical radiation therapy to all metastatic sites in patients with oligometastatic breast cancer should be considered a valuable option, and its recommendation should be individualized.

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