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Locoregional Treatment of the Primary Tumor in Patients With De Novo Stage IV Breast Cancer: A Radiation Oncologist's Perspective

 Seo Hee Choi  ;  Jun Won Kim  ;  Jinhyun Choi  ;  Joohyuk Sohn  ;  Seung Il Kim  ;  Seho Park  ;  Hyung Seok Park  ;  Joon Jeong  ;  Chang-Ok Suh  ;  Ki Chang Keum  ;  Yong Bae Kim  ;  Ik Jae Lee 
 CLINICAL BREAST CANCER, Vol.18(2) : e167-e178, 2018 
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Primary metastatic breast cancer ; Prognosis ; Radiotherapy ; Surgery ; Survival rate
BACKGROUND: The aim of this study was to assess the outcomes of patients with de novo stage IV breast cancer after locoregional treatment (LRT) of primary site. PATIENTS AND METHODS: We studied 245 patients diagnosed with de novo stage IV breast cancer. LRT of the primary tumor (+ systemic therapy) was performed in 82 (34%) patients (surgery, 27; surgery + radiotherapy (RT), 46; and RT, 9). Among those undergoing surgery, 64 (88%) patients underwent mastectomy, and 9 (12%) patients underwent breast-conserving surgery (BCS). Local recurrence-free survival (LRFS) and overall survival (OS) were investigated, and propensity score matching was used to balance patient distributions. RESULTS: The 5-year LRFS and OS rates were 27% and 50%, respectively. Advanced T stage (T4), liver or brain metastasis, >/= 5 metastatic sites, and absence of hormone therapy were significant adverse factors for LRFS, whereas T4 stage and absence of hormone therapy were significant for OS. The LRT group demonstrated significantly more favorable outcomes (5-year LRFS, 61%; 5-year OS, 71%), especially after surgery. After matching, survival rates remained significantly higher for patients who received LRT (5-year LRFS, 62% vs. 20%; P < .001; 5-year OS, 73% vs. 45%; P = .02). BCS + RT was superior to mastectomy +/- RT, which can be attributed to more patients with a low tumor burden undergoing BCS + RT. Outcomes were better with post-mastectomy RT in selected patients (>/= N2, >/= T3, or T2N1). CONCLUSIONS: Upfront LRT including RT is an important option together with systemic therapies for de novo stage IV breast cancer.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Seung Il(김승일)
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Suh, Chang Ok(서창옥)
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
Choi, Jinhyun(최진현)
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