Breast Cancer

, Volume 19, Issue 3, pp 218–237

Possible clinical cure of metastatic breast cancer: lessons from our 30-year experience with oligometastatic breast cancer patients and literature review

Authors

    • Department of Clinical Oncology and HematologyThe Jikei University School of Medicine
  • Tamotsu Ichiba
    • Department of Clinical Oncology and HematologyThe Jikei University School of Medicine
  • Toshikazu Sakuyama
    • Department of Clinical Oncology and HematologyThe Jikei University School of Medicine
  • Yasuhiro Arakawa
    • Department of Clinical Oncology and HematologyThe Jikei University School of Medicine
  • Eijiroh Nagasaki
    • Department of Clinical Oncology and HematologyThe Jikei University School of Medicine
  • Keisuke Aiba
    • Department of Clinical Oncology and HematologyThe Jikei University School of Medicine
  • Hiroko Nogi
    • Department of Breast and Endocrine SurgeryThe Jikei University School of Medicine
  • Kazumi Kawase
    • Department of Breast and Endocrine SurgeryThe Jikei University School of Medicine
  • Hiroshi Takeyama
    • Department of Breast and Endocrine SurgeryThe Jikei University School of Medicine
  • Yasuo Toriumi
    • Department of Breast and Endocrine SurgeryThe Jikei University School of Medicine
  • Ken Uchida
    • Department of Breast and Endocrine SurgeryThe Jikei University School of Medicine
  • Masao Kobayashi
    • Department of Therapeutic RadiologyThe Jikei University School of Medicine
  • Chihiro Kanehira
    • Department of Therapeutic RadiologyThe Jikei University School of Medicine
  • Masafumi Suzuki
    • Department of PathologyThe Jikei University School of Medicine
  • Naomi Ando
    • Department of PharmacologyThe Jikei University Hospital
  • Kazuhiko Natori
    • Department of Hematology and OncologyToho University Omori Medical Center
  • Yasunobu Kuraishi
    • Department of Hematology and OncologyToho University Omori Medical Center
Special Feature From improved survival to potential cure in patients with metastatic breast cancer

DOI: 10.1007/s12282-012-0347-0

Cite this article as:
Kobayashi, T., Ichiba, T., Sakuyama, T. et al. Breast Cancer (2012) 19: 218. doi:10.1007/s12282-012-0347-0

Abstract

Background

Metastatic breast cancer (MBC) is generally incurable. However, 10–20-year relapse-free survival of MBC is approximately 2%, implying that at least a small subset of MBC patients achieve prolonged survival. We therefore analyzed long-term outcome in a particular subset, i.e., oligometastatic breast cancer (OMBC).

Methods

Data of OMBC subjects (N = 75) treated in our institution from April 1980 to March 2010 were retrospectively analyzed. OMBC was identified as: one or 2 organs involved with metastatic lesions (excluding the primary lesion resectable by surgery), fewer than 5 lesions per metastasized organ, and lesion diameter less than 5 cm. Patients were generally treated with systemic chemotherapy first, and those who achieved complete response (CR) or partial response (PR) were further treated, if applicable, with local therapy (surgical or radiation therapy) to maintain CR or to induce no evidence of clinical disease (NED), with additional systemic therapy.

Results

Median follow-up duration was 103 (6–329) months. Single or 2 organs were involved in, respectively, 44 (59%) and 31 (41%) cases with metastatic lesions, 48% of which were visceral. In cases where effects of systemic therapy, possibly in combination with other treatments, were evaluated (N = 68), CR or PR was achieved in 33 (48.5%) or 32 (47.1%), respectively, with overall response rate (ORR: CR + PR) of 95.6% (N = 65). In cases receiving multidisciplinary treatment (N = 75), CR or NED (CR/NED), or PR was induced in 48 (64.0%) or 23 (30.7%) cases, respectively, with ORR (CR/NED + PR) of 94.7% (N = 71). CR rates (60.5%) with systemic therapy and CR/NED rates (79.5%) with multidisciplinary treatment were significantly better in subjects with a single involved organ than in those with two involved organs (P = 0.047 and 0.002, systemic only or multidisciplinary treatments, respectively).

Medians estimated by Kaplan–Meier method were: overall survival (OS) of 185.0 months and relapse-free interval (RFI) of 48.0 months. Estimated outcomes were: OS rates (OSR) of 59.2% at 10 years and 34.1% at 20 years, and relapse-free rates (RFR) of 27.4% at 10 years and 20 years. No disease progression was observed after 101.0 months as RFR. Cases with single organ involvement (N = 44) showed significantly better outcomes (OSR of 73% at 10 years and 52% at 20 years, RFR of 42% at 10 years and 20 years). Those who received local therapies (N = 35) also showed better prognosis: OSR of 82% at 10 years and 53% at 20 years, RFR of 38% at 10 years and 20 years. Three cases (4%) survived for their lifetime without relapse after achieving CR or NED, our definition of clinical cure.

Multivariate analysis revealed factors favoring better prognosis as: none for OS, and single organ involvement with metastasis, administration of local treatment, and shorter disease-free interval (DFI) (P = 0.030, 0.039, and 0.042, respectively) for RFR. Outcomes in OMBC in literature were OSR of 35–73% at 10 years and 26–52% at 20 years, and RFR of 27–42% at 10 years and 26–42% at 20 years.

Conclusions

The present analyses clearly indicate that OMBC is a distinct subgroup with long-term prognosis superior to MBC, with reasonable provability for clinical cure. Further prospective studies to better characterize OMBC are warranted to improve prognosis in MBC.

Keywords

Oligometastatic breast cancerMetastatic breast cancerRelapse-free survivalCureClinical cure

Copyright information

© The Japanese Breast Cancer Society 2012