Abstract
The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive settings are even more common—paving the way to a paradigm change of focal treatments role. In fact, according to immunophenotype, radiotherapy can be considered with radical intent in these settings of patients. The aim of this literature review is to analyze available clinical data on prognosis of bone metastases from breast cancer and benefits of available treatments for developing a practical guide for clinicians.
Highlights
Thanks to treatment implementations [1], metastatic breast cancer (MBC) has shown an improvement of outcomes in the last years
MRI is usually required for stereotactic body radiotherapy (SBRT), in which target of the treatment is the lesion with a millimetric margin and dose are high
The cortical bone may appear preserved, while in secondary lesions, cortical bone is typically destructed. Another possible differential diagnosis is sarcoidosis, because lesions cannot be reliably distinguished from metastatic lesions on routine MRI studies [35]. 18F-FDG Positron emission tomography (PET)/computed tomography (CT) is highly sensitive in detecting granulomatous bone marrow infiltration, but an increased 18F-FDG uptake can mimic metastatic disease, reducing the specificity of 18-FDG positron emission tomography/CT (PET/CT) when both sarcoidosis and a tumor which may develop bone metastases occur in the same patient [36]
Summary
Thanks to treatment implementations [1], metastatic breast cancer (MBC) has shown an improvement of outcomes in the last years. It has been clinically demonstrated that patients obtain an immediate relief of symptoms in 2–4 weeks [11,20,21], and radiologically demonstrated that, for intent-to-eradicate treatments, local controls at 1 and 2 years can achieve 90.3% and 82.4% success with excellent safety [22] For this reason, oligometastatic/oligoprogressive patients are even more challenging because physicians can imbricate local treatments such as radiotherapy with new systemic drugs to achieve higher progression-free survival—and in general, improve overall survival. Oligometastatic/oligoprogressive patients are even more challenging because physicians can imbricate local treatments such as radiotherapy with new systemic drugs to achieve higher progression-free survival—and in general, improve overall survival In these settings, radiotherapy can promote eradication of subclones resistant to systemic therapy. The final purpose is to offer a practical guide for multidisciplinary management of patients with bone metastases from breast cancer
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