Introduction
Patients and methods
Variable | n (%) |
---|---|
Entire cohort of the BBCD | 1459 |
Patients with distant metastases (DM) | 369 (25.3) |
PMD: DM at initial diagnosis | 92 (6.3) |
SMD: DM developed during the course of the illness | 277 (19.0) |
Patients with complete information about disease and therapy course. | 363 |
Last follow-up: alive1 | 23 (6.3) |
Study cohort: patients who died, i.e. patients with completed disease and therapy courses | 340 (93.7) |
Study cohort | 340 |
A. Breast cancer-related radiotherapy | 165 (48.5) |
B. No radiotherapy | 175 (51.5) |
Breast cancer-related radiotherapy
| |
Number of patients | 165 |
Number of series | 255 |
median/mean (range) | 1/1.6 (1-5) |
Number of planning target volumes | 337 |
median/mean (range) | 2/2.0 (1-8) |
Metastatic sites and radiation volumes
| 337 |
Breast and locoregional lymph nodes | 35 (10.4) |
- primary tumor region after surgery (PMD) | 8 (2.4) |
- primary breast tumor without surgery (PMD) | 3 (0.9) |
- recurrence at the chest wall, no surgery | 6 (1.8) |
- chest wall after surgery for local recurrence | 1 (0.3) |
- recurrence at locoregional lymph nodes | 17 (5.0) |
Bone | 217 (64.4) |
- vertebrae and osseous pelvis | 137 (40.7) |
- other sites | 80 (23.7) |
Brain | 57 (16.9) |
Other locations | 28 (8.3) |
- skin/soft tissue | 13 (3.8) |
- mediastinum | 6 (1.8) |
- eye | 3 (0.9) |
- lung | 3 (0.9) |
- cervical lymph nodes | 2 (0.6) |
- liver | 1 (0.3) |
Variable | Group A | Group B |
---|---|---|
Radiotherapy | No radiotherapy | |
n = 165 (%) | n = 175 (%) | |
AJCC/UICC TNM stage at initial diagnosis
| ||
Stage I | 17 (10.3) | 16 (9.1) |
Stage II | 56 (34.0) | 60 (34.3) |
Stage III | 54 (32.7) | 59 (33.7) |
Stage IV | 38 (23.0) | 40 (22.9) |
Histologic subtype
1
| ||
Ductal invasive | 130 (79.3) | 133 (76.9) |
Lobular invasive | 30 (18.3) | 32 (18.5) |
Rare types | 4 (2.4) | 8 (4.6) |
Not available | 1 | 2 |
Grading
1
| ||
G1/2 | 54 (34.6) | 57 (35.2) |
G3 | 102 (65.4) | 105 (64.8) |
Not available | 9 | 13 |
Hormonal receptor status
1
| ||
Positive | 116 (74.8) | 125 (74.4) |
Negative | 39 (25.2) | 43 (25.6) |
Not available | 10 | 7 |
HER2 status, 2002-2009
1,2
|
n = 40 (%)
|
n = 57 (%)
|
Positive | 16 (40.0) | 10 (17.9) |
“Triple-negative” carcinoma | 6 (15.0) | 12 (21.4) |
Not available | - | 1 |
Metastatic disease survival
| ||
<12 months | 80 (45.7) | 46 (27.9) |
12-24 months | 33 (18.9) | 34 (20.6) |
25-48 months | 43 (24.5) | 58 (35.1) |
>48 months | 19 (10.9) | 27 (16.4) |
Radiotherapy: definition of series and planning target volumes
Ethics committtee
Statistical analysis
Results
Radiotherapy vs. no radiotherapy
Radiotherapy within palliative therapy and disease course of metastatic BC
Metastatic sites | Number of patients | Number of patients who had radiotherapy |
---|---|---|
(% of the study cohort, n = 340) | ||
(% of the metastatic site occurrence) | ||
Bone | 237 (69.7) | 108 (45.6) |
Lung | 175 (51.5) | 1 (0.6) |
Liver | 149 (43.8) | 1 (0.7) |
Brain | 64 (18.8) | 55 (85.9) |
Lymph nodes (excluding | 97 (28.5) | 8 (8.2) |
ipsilateral locoregional LNs) | ||
Other locations | 60 (17.6) | 9 (15.0) |
Local recurrence (breast and/or ipsilateral locoregional LNs)1 | 66 (19.4) | 22 (33.3) |
Metastatic sites: | A. All cases | B. Bone | C. Brain | D. Local recurrence (incl. lymph nodes) |
---|---|---|---|---|
255 series (%) | 161 series (%) | 57 series (%) | ||
22 series (%) | ||||
Age (years)
| ||||
Mean/median | 60.6/60 | 60.5/58 | 55.4/57 | 62.6/64.5 |
(range) | (32-89) | (37-89) | (32-80) | (39-86) |
Phase of DMD
| ||||
First third | 127 (49.8) | 88 (54.7) | 16 (28.1) | 15 (68.2) |
Second third | 44 (17.3) | 26 (16.1) | 15 (26.3) | 2 (9.1) |
Last third | 84 (32.8) | 47 (29.2) | 26 (45.6) | 5 (22.7) |
Series performed during:
| ||||
Last 12 months of life | 135 (52.9) | 78 (48.4) | 44 (77.2) | 8 (36.4) |
Last 6 months of life | 95 (37.3) | 53 (32.9) | 33 (57.9) | 5 (22.7) |
Last month of life | 29 (11.4) | 15 (9.3) | 10 (17.5) | 2 (9.1) |
Survival after radiotherapy (months)
| ||||
Mean/median | 17.8/10 | 18.9/14 | 7.6/5 | 23.2/21 |
(range) | (0.2-123) | (0.2-121) | (0.2-29) | (0.5-99) |
Survival, p-values:
| ||||
A vs. B: 0.318 | B vs. C: <0.001 | |||
A vs. C: <0.001 | B vs. D: 0.346 | |||
A vs. D: 0.158 | C vs. D: <0.001 |
No radiotherapy (175 patients) | Radiotherapy: all cases (165 patients) | Radiotherapy: bone (108 patients) | Radiotherapy: brain (55 patients) | |
---|---|---|---|---|
No systemic therapy | 32 (18.3) | 13 (7.8) | 9 (8.3) | 6 (10.9) |
Chemotherapy (CT) only | 42 (24.0) | 44 (26.7) | 24 (22.2) | 26 (47.3) |
Endocrine therapy (ET) only | 49 (28.0) | 31 (18.8) | 23 (21.3) | 3 (5.4) |
CT + ET | 52 (29.7) | 77 (46.7) | 52 (48.2) | 20 (36.4) |
Median number of systemic therapy lines | 2 (1-8) | 3 (1-10) | 3 (1-10) | 3 (1-10) |