142IN - The role of radiation therapy for M1 breast cancer

Date 29 September 2014
Event ESMO 2014
Session ESMO-ESTRO-ESSO: Integration of local therapy with targeted agents in oligometastatic breast cancer
Topics Surgical Oncology
Breast Cancer
Radiation Oncology
Presenter Philip Poortmans
Citation Annals of Oncology (2014) 25 (suppl_4): iv49-iv49. 10.1093/annonc/mdu322
Authors P. Poortmans
  • Radiation Oncology, Radboud university medical centre, 6525 GA - Nijmegen/NL




Stage IV breast cancer patients receive treatment to relieve symptoms and to prolong quality adjusted live expectancy. Local treatments are generally offered to the lowest effective level of surgery or radiation therapy (RT). Retrospective data suggest that local treatment to the primary tumour improves overall survival. A population based SEER study with a median follow-up of 98 months including 3529 patients of which 768 received RT demonstrated that RT improved overall survival (HR 0.80; p < 0.001). Median survival increased from 7 to 15 months. After adjusting for prognostic factors, the addition of RT remained significant (HR 0.86; p = 0.011) [1]. When metastatic disease requires local treatment for palliation of symptoms, in general limited dose RT or extent of surgery is offered. However, a special case might exist when only a limited number of metastasis is found. What changed our vision towards treatment of previously considered incurable metastatic disease? For sure better diagnosis, improved systemic and local therapy. However, our improving understanding of the biological profile and the related clinical behaviour of breast cancer are of utmost importance to individualise the treatments. By continuing to evaluate the results of the multidisciplinary approach in breast cancer we will increase our understanding of the complex interaction between the respective contribution of systemic and locoregional treatments to the final outcome including survival and toxicity. Anyway, by improving systemic therapy the risk of dying due to distant metastasis will decrease, after which the importance of optimising local control of the primary tumour and eventual metastatic deposits will contribute relatively more to survival [2]. A number of prospective randomised studies is currently open or being prepared to demonstrate definitively whether the addition of local(-regional) treatment of the primary tumour and/or oligometastatic disease will improve the outcome of stage IV breast cancer patients. 1. Morgan SC. Primary tumour-directed therapy in the face of metastatic disease: killing the seed or disturbing the soil? ESTRO 33, Vienna, 4-8 April 2014, abstract 2. Poortmans P. Postmastectomy radiation in breast cancer with one to three involved lymph nodes: ending the debate. Epub Lancet 2014 Mar 19.


The author has declared no conflicts of interest.