title: Bone metastases in breast cancer: Frequency, metastatic pattern and non-systemic locoregional therapy.
abstract: BACKGROUND
  The study evaluates the frequency of and indications for bone-metastases (BM)-related surgery and/or radiotherapy in the palliative breast cancer (BC) situation and analyzes in which phase of the palliative disease course surgery and/or radiotherapy was applied.
  
  
  METHODS
  340 patients who developed distant metastatic disease (DMD) and died (i.e. patients with completed disease courses) were analyzed.
  
  
  RESULTS
  From the entire study cohort, 237 patients (69.7%) were diagnosed with BM. Out of these, 116 patients (48.9%) received BM-related radiotherapy and/or surgery during the palliative situation.
  108 patients (45.6%) received 161 series (range: 1-5) with 217 volumina (range: 1-8) on 300 osseous sites. At 75.3% of the radiated sites, the spine was the most frequent radiated location. Eighty-eight series (54.7%) were performed in the first third of the metastatic disease survival (MDS) period. The median survival after radiotherapy was 14 months (range: 0.2-121 months).
  
  
  METHODS
  In 37 patients (15.6%), 50 procedures (range: 1-4) were necessary to stabilize BM. The femur predominated with 56.0% of the procedures. Twenty procedures (40.0%) were performed in the first third of survival follow-up. The median survival after surgery was 13.5 months (range: 0.5-49 months). BC patients with BM had a significantly improved MDS when radiotherapy and/or surgery for skeletal metastases was embedded in the palliative approach (27.5 months vs. 19.5 months, p<0.001). From the 118 patients who had a MDS of ≥24 months, the majority (54.2%) had BM-related radiotherapy and/or surgery during the palliative course.
  
  
  CONCLUSIONS
  Metastatic BC has become increasingly viewed as a chronic disease process. In a general palliative therapy approach, which allows for treatment according to the principles of a chronic disease, non-systemic therapy for BM, in particular radiotherapy, has a clearly established role in the therapy concept.
authors.affiliation: Cantonal Hospital Winterthur, Department of Radiation Therapy and Radiation Oncology, Brauerstrasse 15, CH-8401 Winterthur, Switzerland; Breast Center "SenoSuisse", Brauerstrasse 15, CH-8401 Winterthur, Switzerland.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Steinauer
authors.affiliation: University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland.
authors.forename: Dorothy Jane
authors.initials: DJ
authors.lastname: Huang
authors.affiliation: UHB, Institute of Pathology, Schönbeinstrasse 40, CH-4031 Basel, Switzerland.
authors.forename: Serenella
authors.initials: S
authors.lastname: Eppenberger-Castori
authors.affiliation: Breast Center "SenoSuisse", Brauerstrasse 15, CH-8401 Winterthur, Switzerland; Cantonal Hospital Winterthur, Department of Gynecology & Obstetrics, Brauerstrasse 15, CH-8401 Winterthur, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Amann
authors.affiliation: Breast Center "SenoSuisse", Brauerstrasse 15, CH-8401 Winterthur, Switzerland; University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland; Cantonal Hospital Winterthur, Department of Gynecology & Obstetrics, Brauerstrasse 15, CH-8401 Winterthur, Switzerland.
authors.forename: Uwe
authors.initials: U
authors.lastname: Güth
keywords: Bone metastases; Breast cancer; Palliative radiotherapy; Palliative surgery