title: Repeated chemoembolization followed by laser-induced thermotherapy for liver metastasis of breast cancer.
abstract: OBJECTIVE
  The purpose of this study was to evaluate local tumor control and survival after use of a downstaging protocol of repeated transarterial chemoembolization (TACE) with two chemotherapeutic combinations followed by laser-induced thermotherapy in the care of patients with liver metastasis of breast cancer.
  
  
  METHODS
  This prospective study included 161 patients with liver metastasis of breast cancer origin. TACE (mean, 3.5 [SD, 1.3] sessions per patient; range, 1-9 sessions) was performed as downstaging treatment to achieve the size and number of metastatic lesions that met the requirements for laser-induced thermotherapy (diameter < 5 cm, number ≤ 5). The TACE protocol was performed with either mitomycin C alone (n = 53) or mitomycin C in combination with gemcitabine (n = 108).
  
  
  RESULTS
  In response to TACE overall, the mean reduction in diameter based on the longest diameter of the target lesions was 27%. The difference between diameter reduction in the mitomycin C group and that in the mitomycin C-gemcitabine group was not statistically significant (p = 0.65). The mean survival time of all patients was 32.5 months, calculation starting from the first TACE treatment. The mean local tumor control period calculated as of completion of therapy was 13 months, and the mean time to progression was 8 months. In the mitomycin-gemcitabine group, mean time to progression was 10.7 months, and in the mitomycin group it was 6.9 months (p = 0.5).
  
  
  CONCLUSIONS
  TACE can be used for sufficient downstaging of liver metastatic lesions of breast cancer to allow laser-induced thermotherapy. A combination of mitomycin C and gemcitabine seems to improve the reduction achieved with TACE.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. T.Vogl@em.uni-frankfurt.de
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.forename: Nagy N N
authors.initials: NN
authors.lastname: Naguib
authors.forename: Nour-Eldin A
authors.initials: NE
authors.lastname: Nour-Eldin
authors.forename: Martin G
authors.initials: MG
authors.lastname: Mack
authors.forename: Stefan
authors.initials: S
authors.lastname: Zangos
authors.forename: John E
authors.initials: JE
authors.lastname: Abskharon
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jost
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D003287:Contrast Media; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008113:Liver Neoplasms / Q000628:therapy*; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011446:Prospective Studies; D015641:Radiography, Interventional; D019233:Retreatment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003287:Contrast Media; D003841:Deoxycytidine; D016685:Mitomycin; D019786:Gadolinium DTPA; D000093542:Gemcitabine