Locally ablative treatment of breast cancer liver metastases: identification of factors influencing survival (the Mammary Cancer Microtherapy and Interventional Approaches (MAMMA MIA) study)

BMC Cancer

Research Article

Peter Hass¹  Christiane Bruns²  Maciej PowerskI³  Ingo Steffen³  Sophia Scholz³  Holger Amthauer⁴  Jens Ricke⁴  Konrad Mohnike⁴  Max Seidensticker⁴  Ricarda Seidensticker⁴  Maciej Pech⁵  Patrick Stübs⁶  Felix Popp⁶  Benjamin Garlipp⁶  Serban-Dan Costa⁷ 

[1] Institut für Strahlentherapie, Universitätsklinik Magdeburg, Magdeburg, Germany;International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany;Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany;Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany;Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany;International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany;Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany;International School of Image-Guided Interventions, Deutsche Akademie für Mikrotherapie, Magdeburg, Germany;Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland;Universitätsklinik Magdeburg, Klinik für Allgemein, Viszeral- und Gefäßchirurgie, Magdeburg, Germany;Universitätsklinik Magdeburg, Universitätsfrauenklinik, Magdeburg, Germany;

关键词: Liver metastases;    Breast cancer;    Oligometastases;    Locally ablative therapy;    Liver surgery;   

DOI  :  10.1186/s12885-015-1499-z

 received in 2014-10-14, accepted in 2015-06-18,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundLiver 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.Methods59 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.ResultsMedian 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.ConclusionLocal 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.

【 授权许可】

CC BY   
© Seidensticker et al. 2015