title: Locally ablative treatment of breast cancer liver metastases: identification of factors influencing survival (the Mammary Cancer Microtherapy and Interventional Approaches (MAMMA MIA) study).
abstract: BACKGROUND
  Liver metastases from breast cancer (LMBC) are typically considered to indicate systemic disease spread and patients are most often offered systemic palliative treatment only. However, retrospective studies suggest that some patients may have improved survival with local treatment of their liver metastases compared to systemic therapy alone. In the absence of randomized trials, it is important to identify patient characteristics indicating that benefit from local treatment can be expected.
  
  
  METHODS
  59 patients undergoing radiofrequency ablation (RFA), interstitial brachytherapy (BT), or radioembolization (RE) of LMBC as a salvage treatment were studied. Potential factors influencing survival were analyzed in a multivariate Cox model. For factors identified to have an independent survival impact, Kaplan-Meier analysis and comparison of overall survival (OS) using the log-rank test was performed.
  
  
  RESULTS
  Median OS following local interventional treatment was 21.9 months. Considering only factors evaluable at treatment initiation, maximum diameter of liver metastases (≥3.9 cm; HR: 3.1), liver volume (≥ 1376 mL; HR: 2.3), and history of prior chemotherapy (≥ 3 lines of treatment; HR: 2.5-2.6) showed an independent survival impact. When follow-up data were included in the analysis, significant factors were maximum diameter of liver metastases (≥ 3.9 cm; HR: 3.1), control of LMBC during follow-up (HR: 0.29), and objective response as best overall response (HR: 0.21). Neither the presence of any extrahepatic metastases nor presence of bone metastases only had a significant survival impact. Median OS was 38.7 vs. 16.1 months in patients with metastases < vs. ≥ 3.9 cm, 36.6 vs. 10.2 months for patients having objective response vs. stable/progressive disease, and 38.5 vs. 14.2 months for patients having controlled vs. non-controlled disease at follow-up.
  
  
  CONCLUSIONS
  Local control of LMBC confers a survival benefit and local interventional treatment for LMBC should be studied in a randomized trial. Patients with small metastases and limited history of systemic LMBC treatment are most likely to benefit from local approaches. Limited extrahepatic disease should not lead to exclusion from a randomized study and should not be a contraindication for local LMBC treatment as long as no randomized data are available.
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. max.seidensticker@med.ovgu.de.|International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. max.seidensticker@med.ovgu.de.
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.affiliation: Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany. benjamin.garlipp@med.ovgu.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Garlipp
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. soscholz@googlemail.com.
authors.forename: Sophia
authors.initials: S
authors.lastname: Scholz
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. konrad.mohnike@med.ovgu.de.|International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. konrad.mohnike@med.ovgu.de.
authors.forename: Konrad
authors.initials: K
authors.lastname: Mohnike
authors.affiliation: Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany. felix.popp@med.ovgu.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Popp
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. ingo.steffen@med.ovgu.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Steffen
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. ricarda.seidensticker@med.ovgu.de.|International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. ricarda.seidensticker@med.ovgu.de.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.affiliation: Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany. patrick.stuebs@med.ovgu.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stübs
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. maciej.pech@med.ovgu.de.|International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. maciej.pech@med.ovgu.de.|Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland. maciej.pech@med.ovgu.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. maciej.powerski@med.ovgu.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: PowerskI
authors.affiliation: Institut für Strahlentherapie, Universitätsklinik Magdeburg, Magdeburg, Germany. peter.hass@med.ovgu.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Hass
authors.affiliation: Universitätsklinik Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany. serban-dan.costa@med.ovgu.de.
authors.forename: Serban-Dan
authors.initials: SD
authors.lastname: Costa
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. holger.amthauer@med.ovgu.de.|International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. holger.amthauer@med.ovgu.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
authors.affiliation: International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. christiane.bruns@med.ovgu.de.|Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany. christiane.bruns@med.ovgu.de.
authors.forename: Christiane
authors.initials: C
authors.lastname: Bruns
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany. jens.ricke@med.ovgu.de.|International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany. jens.ricke@med.ovgu.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D017115:Catheter Ablation / Q000379:methods; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome