Radiotherapy in patients with metastatic breast cancer

Abstract

Radiotherapy in metastatic breast cancer is aimed at palliation of symptoms and prevention or improvement of functional deficits. The majority of randomised controlled trials focus on the effect of different fractionation regimens and total radiation doses in the treatment of bone and brain metastasis, and spinal cord compression. Breast cancer patients were well represented in these trials and showed usually considerably better outcome than most other investigated cancers, indicating that metastatic breast cancer is a radiosensitive disease. Typically, about 80−90% of patients with metastatic breast experience significant clinical response to local radiotherapy [1,2]. None of these trials had a control arm without radiotherapy. Overall survival was either not investigated or a secondary end-point with the exception of trials on brain metastasis. Randomised trials on the potential impact of local radiotherapy of primary tumours with or without surgery or asymptomatic distant metastasis on survival have not been conducted. Keeping in mind these limitations, the possible impact on survival of local radiotherapy to the primary site and distant metastasis will be briefly reviewed in the following.