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Title: Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients

Abstract

ObjectiveTo evaluate prognostic factors associated with local control and disease-free-survival (DFS) of oligometastatic breast cancer patients treated by percutaneous thermal ablation (PTA).Materials and MethodsSeventy-nine consecutive patients (54.5 ± 11.2 years old) with 114 breast cancer metastases (28.9 ± 16.1 mm in diameter), involving the lungs, the liver, and/or the bone, were treated using PTA with a curative intent. The goal was to achieve a complete remission in association with systemic chemotherapy and hormonal therapy. We retrospectively evaluated the prognostic factors associated with 1- and 2-year local control and the 1- and 2-year DFS rates.ResultsThe 1- and 2-year local control rates were 83.0 and 76.1 %, respectively. Tumor burden was associated with a poorer outcome for local control after PTA (HR 1.027 by additional millimeter, p = 0.026; >4 cm HR 3.90). The 1- and 2-year DFS rates were 54.2 and 30.4 %, respectively. In multivariate analysis, triple-negative histological subtype and increased size of treated metastases were associated with a poorer DFS (HR 2.22; 95 % CI [1.13–4.36]; p = 0.02 and HR 2.43; 95 % CI [1.22–4.82]; p = 0.011, respectively).ConclusionPTA is effective for local control of breast cancer oligometastases. Tumor burden >4 cm and triple-negative histological subtype are associated with a poorer outcome.

Authors:
 [1];  [2]; ; ;  [1];  [3]; ; ;  [1]
  1. Institut Gustave Roussy, Interventional Radiology Department (France)
  2. Institut Gustave Roussy, Biostatistics and Epidemiology Unit (France)
  3. Centre Clinique de la Porte de Saint-Cloud, Radiotherapy (France)
Publication Date:
OSTI Identifier:
22642503
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 6; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; CHEMOTHERAPY; CONTROL; HORMONES; LIVER; LUNGS; MAMMARY GLANDS; METASTASES; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; PHOSPHORUS 36; SKELETON

Citation Formats

Barral, M., E-mail: matthias-barral@yahoo.fr, Auperin, A., E-mail: anne.auperin@gustaveroussy.fr, Hakime, A., E-mail: thakime@yahoo.com, Cartier, V., E-mail: victoirecartier@hotmail.com, Tacher, V., E-mail: vaniatacher@gmail.com, Otmezguine, Yves, E-mail: yotmezguine@ccps.com, Tselikas, L., E-mail: lambros.tselikas@gmail.com, Baere, T. de, E-mail: thierry.debaere@gustaveroussy.fr, and Deschamps, F., E-mail: frederic.deschamps@gustaveroussy.fr. Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1301-X.
Barral, M., E-mail: matthias-barral@yahoo.fr, Auperin, A., E-mail: anne.auperin@gustaveroussy.fr, Hakime, A., E-mail: thakime@yahoo.com, Cartier, V., E-mail: victoirecartier@hotmail.com, Tacher, V., E-mail: vaniatacher@gmail.com, Otmezguine, Yves, E-mail: yotmezguine@ccps.com, Tselikas, L., E-mail: lambros.tselikas@gmail.com, Baere, T. de, E-mail: thierry.debaere@gustaveroussy.fr, & Deschamps, F., E-mail: frederic.deschamps@gustaveroussy.fr. Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients. United States. doi:10.1007/S00270-016-1301-X.
Barral, M., E-mail: matthias-barral@yahoo.fr, Auperin, A., E-mail: anne.auperin@gustaveroussy.fr, Hakime, A., E-mail: thakime@yahoo.com, Cartier, V., E-mail: victoirecartier@hotmail.com, Tacher, V., E-mail: vaniatacher@gmail.com, Otmezguine, Yves, E-mail: yotmezguine@ccps.com, Tselikas, L., E-mail: lambros.tselikas@gmail.com, Baere, T. de, E-mail: thierry.debaere@gustaveroussy.fr, and Deschamps, F., E-mail: frederic.deschamps@gustaveroussy.fr. 2016. "Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients". United States. doi:10.1007/S00270-016-1301-X.
@article{osti_22642503,
title = {Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients},
author = {Barral, M., E-mail: matthias-barral@yahoo.fr and Auperin, A., E-mail: anne.auperin@gustaveroussy.fr and Hakime, A., E-mail: thakime@yahoo.com and Cartier, V., E-mail: victoirecartier@hotmail.com and Tacher, V., E-mail: vaniatacher@gmail.com and Otmezguine, Yves, E-mail: yotmezguine@ccps.com and Tselikas, L., E-mail: lambros.tselikas@gmail.com and Baere, T. de, E-mail: thierry.debaere@gustaveroussy.fr and Deschamps, F., E-mail: frederic.deschamps@gustaveroussy.fr},
abstractNote = {ObjectiveTo evaluate prognostic factors associated with local control and disease-free-survival (DFS) of oligometastatic breast cancer patients treated by percutaneous thermal ablation (PTA).Materials and MethodsSeventy-nine consecutive patients (54.5 ± 11.2 years old) with 114 breast cancer metastases (28.9 ± 16.1 mm in diameter), involving the lungs, the liver, and/or the bone, were treated using PTA with a curative intent. The goal was to achieve a complete remission in association with systemic chemotherapy and hormonal therapy. We retrospectively evaluated the prognostic factors associated with 1- and 2-year local control and the 1- and 2-year DFS rates.ResultsThe 1- and 2-year local control rates were 83.0 and 76.1 %, respectively. Tumor burden was associated with a poorer outcome for local control after PTA (HR 1.027 by additional millimeter, p = 0.026; >4 cm HR 3.90). The 1- and 2-year DFS rates were 54.2 and 30.4 %, respectively. In multivariate analysis, triple-negative histological subtype and increased size of treated metastases were associated with a poorer DFS (HR 2.22; 95 % CI [1.13–4.36]; p = 0.02 and HR 2.43; 95 % CI [1.22–4.82]; p = 0.011, respectively).ConclusionPTA is effective for local control of breast cancer oligometastases. Tumor burden >4 cm and triple-negative histological subtype are associated with a poorer outcome.},
doi = {10.1007/S00270-016-1301-X},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 39,
place = {United States},
year = 2016,
month = 6
}
  • The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated using the Kaplan-Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was 96%. During follow-upmore » local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months. There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression, and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.« less
  • PurposeTo evaluate the survival outcomes of percutaneous thermal ablation (RFA + microwaves) for patients presenting N0 non-small-cell lung cancer (NSCLC) ineligible for surgery.Materials and MethodsEighty-seven patients from two comprehensive cancer centers were included. Eighty-two patients were treated with RFA electrodes and five with microwave antenna. Overall survival (OS) and disease-free survival (DFS) were estimated and predictive factors of local tumor progression, OS and DFS identified and compared by univariate and multivariate analysesResultsMedian follow-up was 30.5 months (interquartile range 16.7–51) and tumor size was 21 mm (range 10–54 mm). Treatment was incomplete for 14 patients with a local tumor progression of 11.5, 18.3, and 21.1 % atmore » 1, 2, and 3 years, respectively. Two patients presented with neurological (grade III or IV) complications, and one died of respiratory and multivisceral failure as a result of the procedure at 29 days. In univariate analysis, increasing tumor size (P = 0.003) was the only predictive factor related to risk of local tumor progression. 5-year OS and DFS were 58.1 and 27.9 %, respectively. Sex (P = 0.044), pathology (P = 0.032), and tumor size >2 cm (P = 0.046) were prognostic factors for DFS. In multivariate analysis, pathology (P = 0.033) and tumor size >2 cm (P = 0.032) were independent prognostic factors for DFS.ConclusionsOversized and overlapping ablation of N0 NSCLC was well tolerated, effective, with few local tumor progressions, even over long-term follow-up. Increasing tumor size was the main prognostic factor linked to OS, DFS, and local tumor progression.« less
  • Purpose: We previously developed a multigene expression model of tumor radiation sensitivity index (RSI) with clinical validation in multiple independent cohorts (breast, rectal, esophageal, and head and neck patients). The purpose of this study was to assess differences between RSI scores in primary colon cancer and metastases. Methods and Materials: Patients were identified from our institutional review board–approved prospective observational protocol. A total of 704 metastatic and 1362 primary lesions were obtained from a de-identified metadata pool. RSI was calculated using the previously published rank-based algorithm. An independent cohort of 29 lung or liver colon metastases treated with 60 Gy in 5more » fractions stereotactic body radiation therapy (SBRT) was used for validation. Results: The most common sites of metastases included liver (n=374; 53%), lung (n=116; 17%), and lymph nodes (n=40; 6%). Sixty percent of metastatic tumors, compared with 54% of primaries, were in the RSI radiation-resistant peak, suggesting metastatic tumors may be slightly more radiation resistant than primaries (P=.01). In contrast, when we analyzed metastases based on anatomical site, we uncovered large differences in RSI. The median RSIs for metastases in descending order of radiation resistance were ovary (0.48), abdomen (0.47), liver (0.43), brain (0.42), lung (0.32), and lymph nodes (0.31) (P<.0001). These findings were confirmed when the analysis was restricted to lesions from the same patient (n=139). In our independent cohort of treated lung and liver metastases, lung metastases had an improved local control rate compared to that in patients with liver metastases (2-year local control rate of 100% vs 73.0%, respectively; P=.026). Conclusions: Assessment of radiation sensitivity between primary and metastatic tissues of colon cancer histology revealed significant differences based on anatomical location of metastases. These initial results warrant validation in a larger clinical cohort.« less
  • Radioimmune imaging of bone marrow was performed by technetium-99m- (99mTc) labeled antigranulocyte monoclonal antibody BW 250/183 (AGMoAb) scans in 32 patients with suspected bone metastases from primary breast cancer. AGMoAb scans showed bone marrow defects in 25/32 (78%) patients; bone invasion was subsequently confirmed in 23 (72%) patients. Conventional bone scans performed within the same week detected bone metastases in 17/32 (53%) patients (p less than 0.001). AGMoAb scans detected more sites indicating metastatic disease than bone scans in 12 of these 17 patients (71%). All patients with bone metastases in the axial skeleton had bone marrow defects at leastmore » at the sites of bone metastases. Of 15 patients with normal, or indicative of, benign disease bone scans, 8 patients (53%) presented with bone marrow defects in the AGMoAb scans. Bone invasion was confirmed in six of them. AGMoAb bone marrow scans provide a method for the early detection of bone metastatic invasion in patients with breast cancer and suspected bone metastases.« less