Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy.
OBJECTIVE
Several studies suggest that surgical excision of the primary tumor improves survival among patients with stage IV breast cancer at diagnosis. Exclusive locoregional radiotherapy (LRR) is an alternative form of locoregional treatment (LRT) in this setting. We retrospectively studied the impact of LRT on the survival of breast cancer patients with synchronous metastases.


METHODS
Among 18,753 breast cancer patients treated in our institution between 1980 and 2004, 598 patients (3.2%) had synchronous metastasis at diagnosis. Demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The impact of LRT on overall survival (OS) was evaluated by multivariate analysis including known prognostic factors.


RESULTS
Among 581 eligible patients, 320 received LRT (group A), and 261 received no LRT (group B). LRT consisted of exclusive LRR in 249 patients (78%), surgery of the primary tumor with adjuvant LRR in 41 patients (13%), and surgery alone in 30 patients (9%). With a median follow-up time of 39 months, the 3-year OS rates were 43.4% and 26.7% in group A and group B (P =.00002), respectively. The association between LRT and improved survival was particularly marked in women with visceral metastases. LRT was an independent prognostic factor in multivariate analysis (hazard ratio [HR] = 0.70; 95% CI, 0.58 to 0.85; P = .0002). The adjusted HR for late death (>or= 1 year) was 0.76 (95% CI, 0.61 to 0.96; P = .02).


CONCLUSIONS
In our experience, LRT, consisting mainly of exclusive LRR, was associated with improved survival in breast cancer patients with synchronous metastases. Exclusive LRR may thus represent an active alternative to surgery.
Le Scodan
Romuald
R
Department of Radiation Oncology, Centre René Huguenin, 35 rue Dailly, 92210, Saint Cloud, France. lescodan@crh1.org
Stevens
Denise
D
Brain
Etienne
E
Floiras
Jean Louis
JL
Cohen-Solal
Christine
C
De La Lande
Brigitte
B
Tubiana-Hulin
Michelle
M
Yacoub
Sameh
S
Gutierrez
Maya
M
Ali
David
D
Gardner
Miriam
M
Moisson
Patricia
P
Villette
Sylviane
S
Lerebours
Florence
F
Munck
Jean Nicolas
JN
Labib
Alain
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult