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Multicenter Study
. 2020 Apr:145:109-116.
doi: 10.1016/j.radonc.2019.12.019. Epub 2020 Jan 10.

Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis

Elvire Pons-Tostivint  1 , Youlia Kirova  2 , Amélie Lusque  3 , Mario Campone  4 , Julien Geffrelot  5 , Sofia Rivera  6 , Audrey Mailliez  7 , David Pasquier  8 , Nicolas Madranges  9 , Nelly Firmin  10 , Agathe Crouzet  11 , Anthony Gonçalves  12 , Clémentine Jankowski  13 , Thibault De La Motte Rouge  14 , Nicolas Pouget  15 , Brigitte De La Lande  16 , Delphine Mouttet-Boizat  17 , Jean-Marc Ferrero  18 , Lionel Uwer  19 , Jean-Christophe Eymard  20 , Marie-Ange Mouret-Reynier  21 , Thierry Petit  22 , Coralie Courtinard  23 , Thomas Filleron  3 , Mathieu Robain  24 , Florence Dalenc  25
Affiliations
Multicenter Study

Radiation therapy to the primary tumor for de novo metastatic breast cancer and overall survival in a retrospective multicenter cohort analysis

Elvire Pons-Tostivint et al. Radiother Oncol. 2020 Apr.

Abstract

Background: The impact of locoregional treatment (LRT) on overall survival (OS) in de novo metastatic breast cancer (dnMBC) is still under debate, with very few data available regarding exclusive radiotherapy (ERT) as a therapeutic modality.

Methods: We evaluated the impact of ERT, exclusive surgery, or a combination of surgery plus radiotherapy (bimodality therapy, BMT) on survival outcomes in a national real-life dnMBC cohort. The primary and secondary end points were OS and progression free survival (PFS) according to LRT (ERT, exclusive surgery, BMT) and no LRT. Sensitivity analyses were performed using propensity score matched analyses.

Results: From 2008 to 2014, 4507 dnMBC patients were identified. Only patients alive and free from progression under systemic therapy at least 1 year after diagnosis were included (n = 1965). Forty-five percent of patients (891/1965) underwent LRT: 41.1% (n = 366) ERT, 13.7% (n = 122) exclusive surgery, and 45.2% (n = 403) BMT. OS adjusted for major prognostic factors was significantly longer in the ERT and BMT group compared with no-LRT group, but not exclusive surgery (hazard ratio (HR) = 0.63, 95% confidence interval (CI) [0.49, 0.80], p < 0.001, HR = 0.61, 95%CI [0.47, 0.78], p < 0.001 and HR = 0.87, 95%CI [0.61, 1.26], p = 0.466 respectively). Results were similar after matching on a propensity score. ERT, surgery and BMT were all associated with a significantly better PFS in multivariable analysis.

Conclusion: ERT was significantly associated with better OS in dnMBC, in the same magnitude as BMT, compared with no-LRT. However, even with statistical models adjusted for known prognostic factors and propensity score analysis, selection biases cannot be eliminated from observational studies.

Keywords: Cohort study; Exclusive radiotherapy; Locoregional treatment; Propensity score; de novo metastatic breast cancer.

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