Breast Cancer Research and Treatment

, Volume 115, Issue 3, pp 601–608 | Cite as

Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy

  • Michael T. MilanoEmail author
  • Hong Zhang
  • Su K. Metcalfe
  • Ann G. Muhs
  • Paul Okunieff
Clinical Trial


Purpose Prospective pilot study to assess patient outcome after stereotactic body radiation therapy (SBRT) for limited metastases from breast cancer. Methods Forty patients with ≤5 metastatic lesions received curative-intent SBRT, while 11 patients with >5 lesions, undergoing SBRT to ≤5 metastatic lesions, were treated with palliative-intent. Results Among those treated with curative-intent, 4-year actuarial outcomes were: overall survival of 59%, progression-free survival of 38% and lesion local control of 89%. On univariate analyses, 1 metastatic lesion (versus 2–5), smaller tumor volume, bone-only disease, and stable or regressing lesions prior to SBRT were associated with more favorable outcome. Patients treated with palliative-intent SBRT were spared morbidity and mortality from progression of treated lesions, though all developed further metastatic progression shortly (median 4 months) after enrollment. Conclusions SBRT may yield prolonged survival and perhaps cure in select patients with limited metastases. Palliative-intent SBRT may be warranted for symptomatic or potentially symptomatic metastases.


Oligometastases Stereotactic body radiation therapy Breast cancer 



The authors would like to thank the family of Barbara Fogarty for their support. We also thank Laura Brumbaugh for editorial assistance. Paul Okunieff, M.D., received grant support from BrainLAB AG (Heimstetten, Germany) between April 1, 2000, and March 31, 2005.


  1. 1.
    Rubin P, Green J (1968) Solitary metastases. Charles C. Thomas, Springfield, ILGoogle Scholar
  2. 2.
    Milas L, Hunter N, Withers HR (1976) Concomitant immunity to pulmonary metastases of a murine fibrosarcoma: influence of removal of primary tumor by radiation or surgery, of active specific immunization and treatment with Corynebacterium granulosum. Int J Radiat Oncol Biol Phys 1:1171–1178PubMedGoogle Scholar
  3. 3.
    Rosenberg SA (1987) Surgical treatment of metastatic cancer. Lippincott Williams & Wilkins, Philadelphia, PAGoogle Scholar
  4. 4.
    Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13:8–10PubMedGoogle Scholar
  5. 5.
    Hellman S (1994) Karnofsky memorial lecture. Natural history of small breast cancers. J Clin Oncol 12:2229–2234PubMedGoogle Scholar
  6. 6.
    Fisher B (1980) Laboratory and clinical research in breast cancer—a personal adventure: the David A. Karnofsky memorial lecture. Cancer Res 40:3863–3874PubMedGoogle Scholar
  7. 7.
    Fisher B, Redmond C, Fisher ER (1980) The contribution of recent NSABP clinical trials of primary breast cancer therapy to an understanding of tumor biology—an overview of findings. Cancer 46:1009–1025. doi :10.1002/1097-0142(19800815)46:4<1009::AID-CNCR2820461326>3.0.CO;2-HPubMedCrossRefGoogle Scholar
  8. 8.
    Mehta N, Mauer AM, Hellman S et al (2004) Analysis of further disease progression in metastatic non-small cell lung cancer: implications for locoregional treatment. Int J Oncol 25:1677–1683PubMedGoogle Scholar
  9. 9.
    Singletary SE, Walsh G, Vauthey JN et al (2003) A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist 8:241–251. doi: 10.1634/theoncologist.8-3-241 PubMedCrossRefGoogle Scholar
  10. 10.
    Tait CR, Waterworth A, Loncaster J et al (2005) The oligometastatic state in breast cancer: hypothesis or reality. Breast 14:87–93. doi: 10.1016/j.breast.2004.10.003 PubMedCrossRefGoogle Scholar
  11. 11.
    Carey Sampson M, Katz A, Constine LS (2006) Stereotactic body radiation therapy for extracranial oligometastases: does the sword have a double edge? Semin Radiat Oncol 16:67–76. doi: 10.1016/j.semradonc.2005.12.002 PubMedCrossRefGoogle Scholar
  12. 12.
    Timmerman RD, Kavanagh BD, Cho LC et al (2007) Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol 25:947–952. doi: 10.1200/JCO.2006.09.7469 PubMedCrossRefGoogle Scholar
  13. 13.
    Kavanagh BD, McGarry RC, Timmerman RD (2006) Extracranial radiosurgery (stereotactic body radiation therapy) for oligometastases. Semin Radiat Oncol 16:77–84. doi: 10.1016/j.semradonc.2005.12.003 PubMedCrossRefGoogle Scholar
  14. 14.
    Katz AW, Carey-Sampson M, Muhs AG et al (2006) Hypofractionated stereotactic body radiation therapy (SBRT) for limited hepatic metastases. Int J Radiat Oncol Biol Phys 67:793–798. doi: 10.1016/j.ijrobp.2006.10.025 PubMedGoogle Scholar
  15. 15.
    Okunieff P, Petersen AL, Philip A et al (2006) Stereotactic Body Radiation Therapy (SBRT) for lung metastases. Acta Oncol 45:808–817. doi: 10.1080/02841860600908954 PubMedCrossRefGoogle Scholar
  16. 16.
    Milano MT, Katz AW, Schell MC et al (2008) Descriptive analysis of oligometastatic lesions treated with curative-intent stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys (in press)Google Scholar
  17. 17.
    Milano MT, Katz AW, Muhs AG et al (2008) A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions. Cancer 112:650–658. doi: 10.1002/cncr.23209 PubMedCrossRefGoogle Scholar
  18. 18.
    Singh D, Yi WS, Brasacchio RA et al (2004) Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol Biol Phys 58:3–10. doi: 10.1016/S0360-3016(03)01442-1 PubMedCrossRefGoogle Scholar
  19. 19.
    O’Dell WG, Schell MC, Reynolds D et al (2002) Dose broadening due to target position variability during fractionated breath-held radiation therapy. Med Phys 29:1430–1437. doi: 10.1118/1.1485977 PubMedCrossRefGoogle Scholar
  20. 20.
    Therasse P, Arbuck SG, Eisenhauer EA (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216. doi: 10.1093/jnci/92.3.205 PubMedCrossRefGoogle Scholar
  21. 21.
    Rivera E, Holmes FA, Buzdar AU et al (2002) Fluorouracil, doxorubicin, and cyclophosphamide followed by tamoxifen as adjuvant treatment for patients with stage IV breast cancer with no evidence of disease. Breast J 8:2–9. doi: 10.1046/j.1524-4741.2002.08002.x PubMedCrossRefGoogle Scholar
  22. 22.
    Buzdar AU, Blumenschein GR, Montague ED et al (1984) Combined modality approach in breast cancer with isolated or multiple metastases. Am J Clin Oncol 7:45–50. doi: 10.1097/00000421-198402000-00006 PubMedCrossRefGoogle Scholar
  23. 23.
    Holmes FA, Buzdar AU, Kau S-W (1994) Combined-modality approach for patients with isolated recurrences of breast cancer (IV-NED): the M.D. Anderson experience. Breast Dis 7:7–20Google Scholar
  24. 24.
    Blumenschein GR, DiStefano A, Caderao J et al (1997) Multimodality therapy for locally advanced and limited stage IV breast cancer: the impact of effective non-cross-resistance late-consolidation chemotherapy. Clin Cancer Res 3:2633–2637PubMedGoogle Scholar
  25. 25.
    Nieto Y, Cagnoni PJ, Shpall EJ et al (1999) Phase II trial of high-dose chemotherapy with autologous stem cell transplant for stage IV breast cancer with minimal metastatic disease. Clin Cancer Res 5:1731–1737PubMedGoogle Scholar
  26. 26.
    Nieto Y, Nawaz S, Jones RB et al (2002) Prognostic model for relapse after high-dose chemotherapy with autologous stem-cell transplantation for stage IV oligometastatic breast cancer. J Clin Oncol 20:707–718. doi: 10.1200/JCO.20.3.707 PubMedCrossRefGoogle Scholar
  27. 27.
    Hanrahan EO, Broglio KR, Buzdar AU (2005) Combined-modality treatment for isolated recurrences of breast carcinoma: update on 30 years of experience at the University of Texas M.D. Anderson Cancer Center and assessment of prognostic factors. Cancer 104:1158–1171. doi: 10.1002/cncr.21305 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Michael T. Milano
    • 1
    Email author
  • Hong Zhang
    • 1
  • Su K. Metcalfe
    • 1
  • Ann G. Muhs
    • 1
  • Paul Okunieff
    • 1
  1. 1.Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterUSA

Personalised recommendations