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

Breast Neoplasms / radiotherapy Cohort Studies Humans Models, Statistical Retrospective Studies Survival Rate
Cohort study Exclusive radiotherapy Locoregional treatment Propensity score de novo metastatic breast cancer

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192

Informations de publication

Date de publication:
04 2020
Historique:
received: 10 06 2019
revised: 16 12 2019
accepted: 22 12 2019
pubmed: 14 1 2020
medline: 15 4 2021
entrez: 14 1 2020
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1016/j.radonc.2019.12.019 PMID: 31931289
pubmed: 31931289
pii: S0167-8140(19)33519-4
doi: 10.1016/j.radonc.2019.12.019
pii:
doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

109-116

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Auteurs

Elvire Pons-Tostivint (E)

Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France. Electronic address: elvire.pons-tostivint@inserm.fr.

Youlia Kirova (Y)

Radiation Oncology Department, Curie Institute, Paris, France.

Amélie Lusque (A)

Biostatistics Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.

Mario Campone (M)

Medical Oncology Department, René Gauducheau Center, Institute de Cancérologie de l'Ouest (ICO), Saint-Herblain, France.

Julien Geffrelot (J)

Radiation Oncology Department, François Baclesse Center, Caen, France.

Sofia Rivera (S)

Radiation Oncology Department, Gustave Roussy Institute, Villejuif, France.

Audrey Mailliez (A)

Medical Oncology Department, Oscar Lambret Center, Lille, France.

David Pasquier (D)

Radiation Oncology Department, Oscar Lambret Center, Lille, France.

Nicolas Madranges (N)

Medical Oncology Department, Bergonié Institute, Bordeaux, France.

Nelly Firmin (N)

Medical Oncology Department, Cancer Institute, Montpellier, France.

Agathe Crouzet (A)

Surgery Department, Henri Becquerel Center, Rouen, France.

Anthony Gonçalves (A)

Medical Oncology Department, Paoli-Calmettes Institute, Marseille, France.

Clémentine Jankowski (C)

Surgery Department, Georges-François Leclerc Center, Dijon, France.

Thibault De La Motte Rouge (T)

Medical Oncology Department, Eugène Marquis Center, Rennes, France.

Nicolas Pouget (N)

Surgery Department, René Huguenin Center, Curie Institute, Saint Cloud, France.

Brigitte De La Lande (B)

Radiation Oncology Department, René Huguenin Center, Curie Institute, Saint-Cloud, France.

Delphine Mouttet-Boizat (D)

Surgery Department, Curie Institute, Paris, France.

Jean-Marc Ferrero (JM)

Medical Oncology Department, Antoine Lacassagne Cancer Center, Nice, France.

Lionel Uwer (L)

Medical Oncology Department, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France.

Jean-Christophe Eymard (JC)

Medical Oncology Department, Jean Godinot Institute, Reims, France.

Marie-Ange Mouret-Reynier (MA)

Medical Oncology Department, Jean Perrin Center, Clermont-Ferrand, France.

Thierry Petit (T)

Medical Oncology Department, Paul Strauss Center, Strasbourg, France.

Coralie Courtinard (C)

Biostatistics Unit, Curie Institute, PSL Research University, Paris, France.

Thomas Filleron (T)

Biostatistics Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.

Mathieu Robain (M)

Biostatistics Unit, Curie Institute, PSL Research University, Paris, France; Department of Research and Development, R&D Unicancer, Paris, France.

Florence Dalenc (F)

Medical Oncology Department, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France.

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Classifications MeSH

questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Maladies du sein › Tumeurs du sein › Radiation therapy to the primary tumor for de...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Radiation therapy to the primary tumor for de...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Radiation therapy to the primary tumor for de...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Modèles statistiques › Radiation therapy to the primary tumor for de...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Radiation therapy to the primary tumor for de...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Taux de survie › Radiation therapy to the primary tumor for de...