title: Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Centre René Huguenin, 35 rue Dailly, 92210, Saint Cloud, France. lescodan@crh1.org
authors.forename: Romuald
authors.initials: R
authors.lastname: Le Scodan
authors.forename: Denise
authors.initials: D
authors.lastname: Stevens
authors.forename: Etienne
authors.initials: E
authors.lastname: Brain
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Floiras
authors.forename: Christine
authors.initials: C
authors.lastname: Cohen-Solal
authors.forename: Brigitte
authors.initials: B
authors.lastname: De La Lande
authors.forename: Michelle
authors.initials: M
authors.lastname: Tubiana-Hulin
authors.forename: Sameh
authors.initials: S
authors.lastname: Yacoub
authors.forename: Maya
authors.initials: M
authors.lastname: Gutierrez
authors.forename: David
authors.initials: D
authors.lastname: Ali
authors.forename: Miriam
authors.initials: M
authors.lastname: Gardner
authors.forename: Patricia
authors.initials: P
authors.lastname: Moisson
authors.forename: Sylviane
authors.initials: S
authors.lastname: Villette
authors.forename: Florence
authors.initials: F
authors.lastname: Lerebours
authors.forename: Jean Nicolas
authors.initials: JN
authors.lastname: Munck
authors.forename: Alain
authors.initials: A
authors.lastname: Labib
mesh_terms: 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