Impact Of Locoregional Treatment Research Articles

Abstract PO5-05-12: Loco-regional Treatment in De Novo Bone Only Metastatic Breast Cancer; Prospective, Multi-Institutional Real-World Data, BOMETIN, Protocol MF14-1a

Abstract Introduction: The impact of loco-regional treatment (LRT) on survival in de novo bone-only metastatic breast cancer (BC) is controversial. The aim of this study is to assess the effect of LRT on survival utilizing international, prospectively acquired data in this cohort of patients. Materials and Methods: Patients with de novo metastatic BC with bone-only metastases were divided into two groups: those receiving systemic therapy only (ST) and those undergoing LRT. Patients who received LRT were divided into two groups: those who received ST after LRT (LRT+ST arm) and those who received ST prior to LRT (ST+LRT arm). Solitary or multiple bone metastases were classified, and factors associated with disease progression were analyzed. Results: There were a total of 744 patients with de novo bone-only metastatic BC treated at each of the participating institutions between 2014 and 2022, with 372 (50%) participants in each arm. Median follow-up was 48 months (32-66, 25-75%). Patients in the LRT group were significantly younger than the ST group [50 (42, 60) vs 55 (44, 66), p=0.0001]. There were no significant differences in grade, Her2 neu and triple negative status, receipt of hormonal therapy and intervention to metastatic sites. During follow-up, 58% (n=217) of patients in ST arm and 32% (n=120) of patients in LRT arm died (p< 0.001). Local progression was observed in 20% of the patients in the ST arm whereas it was 9% in the LRT arm (p=0.0001). Systemic progression occurred more in ST arm; 66% (n=244) compared to 41% (n=152) of patients in LRT group (p< 0.001). The Hazard of death was 64% lower in LRT group than in ST group (HR: 0.36, 95% CI: 0.29-0.45), p<0.0001). The burden of metastatic disease was significantly different between groups with the solitary bone metastasis rate higher in LRT group than the ST only group (50% vs 24%, p< 0.001). However, the LRT group had better overall survival for both solitary (HR: 0.38, 95% Cl: 0.26-0.55) and multiple (HR: 0.38, 95% Cl: 0.29-0.51) bone metastases patients. Within the LRT group, survival rates were similar whether the breast surgery was performed before or after ST.Multivariate Cox analysis showed that LRT and ER/PR positivity significantly decrease the hazard of death (p< 0.05). Conclusion: Analysis of this large multi-institutional patient cohort provides further evidence that LRT improves overall survival and lowers loco-regional recurrence in patients with de novo bone-only metastatic BC. In breast cancer patients with bone-only metastases at presentation, the decision for LRT should be made through a multidisciplinary approach with consideration of surgical therapy at the primary tumor. Citation Format: Atilla Soran, Serdar Ozbas, Lutfi Dogan, Didem Can Trabulus, Jamila El-Azrhi, Kazim Senol, Berk Goktepe, Shruti Zaveri, Salyna Meas, Umut Demirci, Hasan Karanlik, Aykut Soyder, Ahmet Dağ, Ahmet Bilici, Mutlu Dogan, Mehmet Ali Nahit Sendur, Hande Koksal, Mehmet Ali Gulcelik, Neslihan Cabıoğlu, Levent Yeniay, N. Zafer Utkan, Nuri Karadurmus, Gul Daglar, Turgay Simsek, Birol Yildiz, Cihan Uras, Mustafa Tukenmez, Cihangir Ozaslan, Niyazi Karaman, Arda Isik, Berkay Demirors, Efe Sezgin, Vahit Ozmen, Anthony Lucci. Loco-regional Treatment in De Novo Bone Only Metastatic Breast Cancer; Prospective, Multi-Institutional Real-World Data, BOMETIN, Protocol MF14-1a [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-12.

Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer undergoing Upfront Surgery.

Randomized, controlled trials comparing breast-conserving therapy (BCT) with mastectomy have demonstrated equivalent overall survival (OS), but recent observational studies have shown improved OS in patients undergoing BCT. These studies provide limited data on young patients who are traditionally offered mastectomy due to perceived higher disease risk. This study examines the OS in a contemporary series of young women with breast cancer undergoing upfront BCT compared with mastectomy. Women ≤40 years old with primary invasive T1-T2, N0-N1 breast cancer were identified from the National Cancer Database between 2006 and 2016. Patient cohorts were based according to locoregional treatment: BCT, mastectomy alone (Mx), and mastectomy with radiotherapy (Mx/RT). Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) were performed to account for treatment selection bias effects in OS. A total of 15,611 patients met the study criteria; 9,509 patients (60.9%) had BCT, 4,020 (25.8%) had Mx/RT, and 2,082 (13.3%) had Mx alone. The median follow-up was 4.6 years (interquartile range [IQR] 3.0-6.4). After IPTW-adjustment, the 5-year OS was similar for BCT (95%), Mx (95%), and Mx/RT (94%), and there was no significant difference in OS in Mx (hazard ratio [HR] = 1.16, 95% confidence interval [CI] 0.90-1.51) and Mx/RT (HR = 1.08, 95% CI 0.88-1.34) compared with BCT. Mx/RT was associated with decreased survival in patients with pT2N0 (HR = 1.78, 95% CI 1.12-2.84). Among young patients with early-stage breast cancer, overall survival was equivalent regardless of surgical approach. Breast-conserving therapy remains a safe option in young women despite the clinical tendency to offer upfront mastectomy in young patients.

ASO Visual Abstract: Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer Undergoing Upfront Surgery.

ASO Visual Abstract: Impact of Locoregional Treatment on Survival in Young Patients with Early-Stage Breast Cancer Undergoing Upfront Surgery.

Breast Cancer-Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment.

Patients fear lymphedema as an unpredictable daily reminder of breast cancer treatment. The medical community has assumed for years that the development of breast cancer–related lymphedema (BCRL) stemmed solely from the primary surgical extirpation of the axillary lymph nodes. However, contemporary data suggest that BCRL development is multifactorial, influenced by multimodality locoregional and systemic treatment strategies and perhaps by the individual patient’s ability to form collateral lymphatic pathways after injury, as well as potentially modifiable risk factors such as body mass index (BMI). Understanding the interaction between comprehensive locoregional treatment strategies and their collective impact on overall survival and long-term adverse effects such as BCRL is critical to providing patients individualized treatment recommendations. Herein, we review important factors for the development, diagnosis, prevention, and treatment of BCRL that should be considered when determining the contemporary locoregional management of breast cancer.

The impact of locoregional treatment on response to nivolumab in advanced platinum refractory head and neck cancer: The need trial.

e18508 Background: Immunotherapy is the standard of care in the treatment of platinum-refractory recurrent/metastatic head and neck squamous cell carcinoma (R/M-HNSCC). Previous loco-regional treatment could have an impact on the immune system and response to Nivolumab. The aim of this study is to evaluate the efficacy and safety of Nivolumab in a real world population, identifying the impact of the clinic-pathological characteristics and previous treatment in prediction of early progression. Methods: This is a observational, multicenter retrospective/prospective study including patients (pts) with platinum refractory R/M HNSCC who received Nivolumab 240 mg every 2 weeks until disease progression or unacceptable toxicity, from October 2018 to October 2019. We analyzed treatment outcomes in term of early progression (within 3 months), clinical benefit, progression free survival (PFS) and overall survival (OS). To determine the influence on outcomes, the following variables were investigated: primary tumor sub-site, age, gender, ECOG, previous loco-regional treatment, previous systemic therapy, metastatic site. Results: Data from 61 pts were reviewed: 15 oral cavity, 14 oropharynx, 7 hyphofarynx, 19 larynx, 6 paranasal sinus. Median age was 66 years (29-82), 48 pts were men. Forty-nine pts (80%) had performance status (ECOG) ≥ 1 at baseline evaluation. Eleven pts (18%) had only loco-regional recurrence, while 50 pts (82%) had one or more metastatic site. 32 (52%) and 17 pts (28%) had smoking and alcohol abuse history, respectively. 44 pts (72%) received surgery followed by adjuvant radiant treatment at standard dose (28, 46%) or concomitant definitive radiotherapy (16, 26%) as upfront treatment with curative intent. With a median follow up of 4 months (range 1-11), early progression occurred in 39 pts during Nivolumab treatment (64%), while clinical benefit (stable disease and partial response) was achieved in 22 pts (36%). No G3-G4 toxicities occurred. Early progression to Nivolumab was significantly associated to previous loco-regional treatment both at univariate and multivariate analysis (p=0.003 and p= 0.04, respectively). Conclusions: Nivolumab in R/M HNSCC is effective and safe even though burdened with a high early progression rate. Loco-regional treatment, including wide neck dissection and high dose radiotherapy, may compromise the efficacy of Nivolumab, distorting the anatomy of the local lymphatic system and hindering the priming of immune response.

The Impact of Locoregional Treatment on Response to Nivolumab in Advanced Platinum Refractory Head and Neck Cancer: The Need Trial.

Background: Previous locoregional treatment could affect the response to nivolumab in platinum-refractory recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). The aim of this study is to evaluate the impact of the clinicopathological characteristics and previous treatment in predicting early progression to nivolumab in a real-world population. Methods: This is an observational, multicenter retrospective/prospective study including patients (pts) with platinum refractory R/M HNSCC who received nivolumab 240 mg every 2 weeks from October 2018 to October 2019. We analyzed the association between previous treatment, clinicopathological characteristics, and early progression (within 3 months). Results: Data from 61 pts were reviewed. Median age was 67 years (30–82). Forty-two pts (69%) received previous locoregional treatment. Early progression to nivolumab occurred in 36 pts (59%), while clinical benefit (stable disease and partial response) was achieved in 25 pts (41%). Early progression to nivolumab was significantly associated to previous locoregional treatment both at univariate and multivariate analysis (p = 0.005 and p = 0.048, respectively). Conclusion: nivolumab in R/M HNSCC is burdened with a high early progression rate. Previous wide neck dissection and high dose radiotherapy may compromise the efficacy of nivolumab, distorting the anatomy of the local lymphatic system and hindering the priming of immune response.

The Impact of Locoregional Treatment on Survival in Patients With Metastatic Breast Cancer: A National Cancer Database Analysis

BackgroundAlthough systemic therapy is the standard treatment for metastatic breast cancer, the value of locoregional treatment (LRT) of the primary tumor and its impact on survival is controversial. This study evaluates survival outcomes in patients with metastatic breast cancer after receiving LRT (surgery and/or radiation therapy) of the primary tumor. Materials and MethodsThe National Cancer Database was used to identify 16,128 qualifying cases of metastatic breast cancer who received systemic therapy with or without LRT from 2004 to 2013. Treatment modality was divided into surgery (Sx), radiation therapy (RT), surgery followed by RT (Sx + RT), and no LRT. The median survival and 3-year actuarial survival rates (OS) were analyzed for each treatment group. On multivariate analyses, adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using Cox regression modeling to adjust for patient and clinicopathologic characteristics. ResultsOverall, the median follow-up was 28.3 months, and the median survival for all patients was 37.2 months. With 9761 deaths reported, the estimated 3-year OS was 51.3%. The Sx + RT group (n = 2166) had the highest 3-year OS of 69.4%, followed by the Sx group (n = 4293) with 57.6%, the no LRT group (n = 8955) with 44.3%, and the RT group (n = 714) with 41.5% (P < .0001). On multivariate analysis, compared with the no LRT group, a decreased HR was noted in patients receiving Sx (adjusted HR, 0.68; 95% CI, 0.65-0.71; P < .0001) and Sx + RT (adjusted HR, 0.46; 95% CI, 0.43-0.49; P < .0001). ConclusionLRT, especially surgery followed by RT, in addition to systemic therapy, was associated with improved survival in patients with metastatic breast cancer.

Abstract P1-16-02: The impact of locoregional treatment on survival in patients with metastatic breast cancer: A national cancer database analysis

Abstract Purpose and Objectives: Although systemic therapy is the standard treatment for metastatic breast cancer, the value of locoregional treatment (LRT) to the primary tumor and its impact on survival is controversial. This study evaluates survival outcomes in patients with metastatic breast cancer after receiving LRT (surgery and/or radiation therapy) to the primary tumor. Materials and Methods: The National Cancer Database (NCDB) identified 16,128 qualifying cases of stage IV breast cancer (M1, 2004-2013) who received systemic therapy with or without local therapy. Treatment modality was divided into surgery, radiation therapy (RT), surgery with RT (Sx+RT), and no LRT. Median survival and three-year actuarial survival rates (OS) were analyzed for each treatment group. On multivariate analyses, adjusted hazard ratios (HR) with 95% confidence interval were computed using Cox regression modeling to adjust for patient characteristics, year of diagnosis, clinical T and N staging, and facility type. Additionally, survival outcomes for each treatment group were analyzed by metastasis groups (bone, visceral, multiple). Results: A temporal trend of each treatment modality used in years 2004 – 2013 illustrated that the relative use of LRT decreased from 47.2% to 36.2% (p for trend = 0.041). Overall, the median follow-up was 28.3 months and median survival for all patients was 37.2 months. With 9,761 deaths reported, the estimated 3-year survival rate for all patients was 51.3%. The Sx+RT group (n = 2,166) had the highest 3-year survival rate of 69.4%, followed by the surgery group (n = 4,293) with 57.6%, no LRT group (n = 8,955) with 44.3%, and RT group (n = 714) with 41.5% (p &amp;lt; 0.0001). On multivariate analysis, a decreased hazard of death (adjusted HR, 95% CI) was noted in radiation patients compared to no LRT group but without statistical significance (0.91, 0.81-1.0, p = 0.057). Patients receiving surgery (0.68, 0.65-0.71, p &amp;lt; 0.0001) and Sx+RT group (0.46, 0.43-0.49, p &amp;lt; 0.0001) reported statistically significant improved survival compared to the no LRT group. Additionally, later year of diagnosis, low Charlson-Deyo score, high income, private insurance, white race, age 18 - &amp;lt;50, low T and N stage, ductal histology, positive ER/PR/HER2 status, bone only metastasis, and academic facility type were considered favorable factors for OS. When stratified by metastasis type, patients with bone metastasis had the longest 3-year survival rates (74.4% for Sx+RT, 69.4% for surgery, 53.8% for no LRT, 49.3% for RT, p &amp;lt; 0.0001) whereas patients with multiple metastases had the worst outcomes (56.0% for Sx+RT, 43.5% for surgery, 37.9% for no LRT, 34.4% for RT, p = 0.003). Conclusion: Patients with metastatic breast cancer have a large range of survival rates. Locoregional treatment, especially surgery followed by RT, in addition to systemic therapy was associated with improved survival in metastatic breast cancer patients. When survival rates for each treatment modality was stratified by metastasis location, the most favorable survival was observed for the surgery with follow-up radiation group, which is consistent with the overall analysis. Citation Format: Kim KN, Huang D, Qureshi MM, Ko NY, Hirsch AE. The impact of locoregional treatment on survival in patients with metastatic breast cancer: A national cancer database analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-16-02.

A Single Case of Two Synchronous Metastatic Tumours

The incidence of multiple primary tumours increases with age and due to multiple other factors as environmental and genetic predisposition. The authors describe a case of a 77-year-old female patient with diagnosis in September 2009 of colon mucinous adenocarcinoma. She was submitted to surgery, considered R1 and adjuvant chemotherapy. Six months after treatment she had abdominal recurrence on a nodular lesion in peritoneal fat. The patient was submitted to surgery and did multiple courses of systemic treatment. She underwent cytoreductive surgery with hyperthermic chemotherapy, too. In December 2014 she presented a nodular lesion on the bladder and after excision, the histology confirmed a high-grade transitional cell carcinoma and she maintains treatment with endovesical BCG instillations. After that, she had no evidence of peritoneal disease progression. Besides the bad prognosis associated to peritoneal disease, our case report describes a long survival (5 years with no disease progression) in a patient with high risk at diagnosis to peritoneal recurrence. This case shows the importance of multimodal approach and the impact of locoregional treatment in localized metastatic disease.

Impact of Locoregional Treatment on Prognosis of de novo Stage IV Breast Cancer: A Retrospective Long-Term Study of Chinese Population

Objectives: This study aimed to evaluate the impact of locoregional resection and radiotherapy on the prognosis of Chinese women with stage IV breast cancer. Methods: The retrospective study included Chinese patients with de novo stage IV breast cancer in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, between January 1, 2001, and December 31, 2016. The patients were classified into surgery and nonsurgery groups. Overall survival (OS) and distant progression-free survival (DPFS) were evaluated at the last follow-up. Results: Of the 157 patients, 66 (42.0%) underwent surgery and 52 (33.1%) received locoregional radiotherapy. The follow-up time ranged from 3 to 180 months. The median patient follow-up was 54.5 months. The patients in the surgery group had longer 5-year OS and 5-year DPFS compared with the patients in the nonsurgery group. DPFS was also significantly longer in patients who received radiotherapy. Two factors proved to be associated with survival: response to systemic therapy and surgical treatment. Multivariate analysis also showed that the progestogen receptor status significantly influenced the DPFS. Conclusion: Locoregional surgery and radiotherapy of primary tumor might be beneficial for Chinese patients with stage IV breast cancer. It proposed that surgical resection for selected stage IV breast cancer patients.

Abstract P1-14-02: Impact of loco-regional treatment (LRT) on overall-survival (OS) in patients with de novo metastatic breast cancer (MBC): Results of the French ESME multicenter national observational programme

Abstract Background Previous retrospective studies and meta-analysis suggest an improved overall survival (OS) brought by loco-regional treatment (LRT) of primary tumor in de novo metastatic breast cancer (MBC) patients (pts), while prospective trials have mixed results. Most of the previous studies recruited pts before 2005 and consequently did not include recent medical therapies and advances used in MBC. Patients and methods The ESME database include individual data from MBC pts diagnosed between 2008 and 2014, who initiated their treatment in 1 of the 18 participating French comprehensive cancer centers. Our first aim was to study the impact of LRT, defined as surgery, radiotherapy or both, on OS in de novo MBC pts, defined as pts diagnosed with synchronous metastasis or within 90 days from diagnosis of primary tumor. OS was calculated from the date of diagnosis of metastatic stage and was estimated by the Kaplan Meier method. Univariate and multivariate analyses were performed using Logrank-test and Cox-model, respectively. Results Of the total ESME cohort (16703 pts), 4507 (26.9%) were diagnosed with de novo MBC and 4276 fulfilled inclusion criteria for the present study. Median age was 60 years. 66.3% pts had T3-T4. 13.1% (n=495) had triple-negative (TN) BC, 24.4% (n=918) HER2+ BC and 62.5% (n=2536) HR+/HER2- BC. Sites of metastases were bone (69%), liver (30.9%), nodes (29.5%) and lung (25.7%). 77.4% had less than 3 sites involved by metastatic disease. Of 4276 pts, 1706 (39.9%) received a LRT. Among them, 444 (26%) and 535 (31.4%) had surgery or radiotherapy alone respectively, 727 (42.6%) had a combination of both. 99% of pts received a systemic treatment: hormone therapy for 60.3% and chemotherapy +/- targeted therapy for 72.8% of them. Compared with pts with no LRT, pts in the LRT group were younger (median age: 57 vs 61 years, p&amp;lt;0.0001), had smaller tumor (40.4% ≤ T2 vs 28.2%, p&amp;lt;0.0001) with more N0 status (26.5% vs 19.3%, p&amp;lt;0.0001), and different phenotypes: TN 12.1% vs 13.8%; HER2+ 26.4% vs 23.1%; HR+/HER2- 61.5% vs 63.1% (p=0.0447). Metastatic disease in the LRT group was more likely to be limited to 1 or 2 sites (86.4% vs 71.4%), with more non-visceral sites (52.3% vs 36.5%). With a median follow-up of 45.3 m, median OS and initial PFS for the whole population were 45.2 m [95%CI: 43.3-47.1] and 13.8 m [95%CI: 13.2-14.4], respectively. Median OS for TN, HR+/HER2- and HER2+ pts were 19 m [95%CI:17-21], 47.4 m [95%CI: 45.2-50.4] and 53.3 m [95%CI: 48.9-60.2], respectively. By multivariate analysis, LRT was an independent prognostic factor for OS (HR=0.76; 95%CI: 0.64-0.89; p=0.001), together with age, histological subtype, number and patterns of metastatic sites. More advanced analyses will be presented in December. &amp;lt;/del&amp;gt; Conclusion As in older series, this work finds that de novo MBC pts treated after 2008 may derive a prolonged OS, extending up to 4 years for HR+ and HER2+ subgroups. Given the classical prescription biases in such retrospective works, this should be carefully interpreted but might help in better selecting those pts for whom such strategy would be beneficial. Citation Format: Pons-Tostivint EEPT, Kirova YYK, Lusque AAL, Campone MMC, Levy CCL, Delaloge SSD, Mailliez AAM, Madrange NMD, Firmin NNF, Crouzet AAC, Gonçalves AAG, Jankowski CCJ, Lefeuvre CCL, De la Lande BBD, Puget NNP, Bachelot TTB, Ferrero J-MJMF, Uwer LLU, Eymard J-CJCE, Mouret-Reynier M-AMR, Petit TTP, Berchery DDB, Robain MMR, Filleron TTF, Cailliot CCC, Dalenc FFD. Impact of loco-regional treatment (LRT) on overall-survival (OS) in patients with de novo metastatic breast cancer (MBC): Results of the French ESME multicenter national observational programme [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-14-02.

Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma

ObjectivesIn this study, we tried to evaluate the efficacy of locoregional treatment (LRT) in patients with metastatic breast carcinoma (MBC). Materials and methodsThe medical records of 227 patients with MBC at initial presentation between April 1999 and January 2013 were retrospectively evaluated. The median age at diagnosis was 50 years (range, 27–83 years). Thirty-nine patients (17%) had no LRT. Among patients who had LRT, 2 (1%) had locoregional radiotherapy (RT) alone, 54 (29%) had surgery alone [mastectomy, n = 50; breast conserving surgery (BCS), n = 4] and 132 (70%) had surgery (mastectomy, n = 119; BCS, n = 13) followed by locoregional RT. ResultsThe median follow-up time was 35 months (range, 4–149 months). Five-year OS and PFS rates were 44% and 20%, respectively. In both univariate and multivariate analysis LRT per se did not affect OS and PFS rates. However, the 5-year OS and PFS rates were significantly higher in patients treated with locoregional RT than the ones who were not. The corresponding rates were 56% vs. 24% for OS and 27% vs. 7% for PFS (p < 0.001). Median survival was 67 months and 37 months, respectively. ConclusionOur study showed that patients with MBC who received postoperative locoregional RT may have a survival advantage compared with patients who were only treated by surgery. A phase III trial testing the role of adjuvant locoregional RT may help to distinguish patients who will benefit from adjuvant RT.

PO-0699: Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma

Objectives: In this study, we tried to evaluate the efficacy of locoregional treatment (LRT) in patients with metastatic breast carcinoma (MBC). Materials and methods: The medical records of 227 patients with MBC at initial presentation between April 1999 and January 2013 were retrospectively evaluated. The median age at diagnosis was 50 years (range, 27e83 years). Thirty-nine patients (17%) had no LRT. Among patients who had LRT, 2 (1%) had locoregional radiotherapy (RT) alone, 54 (29%) had surgery alone [mastectomy, n ¼ 50; breast conserving surgery (BCS), n ¼ 4] and 132 (70%) had surgery (mastectomy, n ¼ 119; BCS, n ¼ 13) followed by locoregional RT. Results: The median follow-up time was 35 months (range, 4e149 months). Five-year OS and PFS rates were 44% and 20%, respectively. In both univariate and multivariate analysis LRT per se did not affect OS and PFS rates. However, the 5-year OS and PFS rates were significantly higher in patients treated with locoregional RT than the ones who were not. The corresponding rates were 56% vs. 24% for OS and 27% vs. 7% for PFS (p < 0.001). Median survival was 67 months and 37 months, respectively. Conclusion: Our study showed that patients with MBC who received postoperative locoregional RT may have a survival advantage compared with patients who were only treated by surgery. A phase III trial testing the role of adjuvant locoregional RT may help to distinguish patients who will benefit from adjuvant RT.

Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria

Liver transplantation (LT) is a validated treatment for selected cirrhotics with hepatocellular cancer (HCC). A retrospective single center study including 137 recipients having proven HCC was done to refine inclusion criteria for LT as well as to look at impact of locoregional treatment (LRT) on outcome. At pre-LT imaging, 42 (30.6%) patients were Milan criteria (MC)-OUT; 28 (20.4%) were University of California San Francisco criteria (UCSFC)-OUT. Pre-LT LRT was performed in 109 (79.6%) patients. Multivariate analysis identified four factors to be independently predictive of recurrence: tumour number >3, AFP level ≥400 ng/ml, microvascular invasion and rejection needing anti-lymphocytic antibodies. When considering pre-transplant variables only, AFP level ≥400 ng/ml (HR = 5.13; P < 0.0001) was the unique risk factor for recurrence; conversely, application of LRT was protective (HR = 0.42; P = 0.04). MC-IN patients having LRT (n = 79) had the best 5-year tumour-free survival (TFS) (91.6%). MC-IN patients without LRT (n = 16) and MC-OUT patients with LRT (n = 30) had similar good TFS (72.7% vs.77.5%); finally MC-OUT patients without LRT (n = 12) had the worst results (45.0%; vs. 1st group: P < 0.0001). Immediate pre-LT AFP and aggressive pre-transplant LRT strategy, especially in MC-OUT patients, are both important elements to further expand inclusion criteria without compromising long-term results of HCC liver recipients.

Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis

Although adequate locoregional treatment improves local and regional control in early-stage breast cancer, uncertainty still exists about the role of locoregional therapy with respect to survival. To study the impact of surgery and radiotherapy on locoregional control and survival, we combined the data of three European Organisation for Research and Treatment of Cancer (EORTC) Breast Cancer Group trials including early-stage breast cancer patients with long-term follow-up. Risk ratios (RR) were estimated for locoregional recurrence and overall survival using Cox regression models. All analyses were adjusted for tumour size, nodal status, age, adjuvant radiotherapy, adjuvant chemotherapy and trial. The combined data-set consisted of 3648 patients. The median follow-up period was 11 years. 5.9% of the patients who underwent mastectomy and 10.8% of the patients who underwent breast-conserving therapy had a locoregional recurrence (P<0.0001). The risk of death after breast-conserving therapy was similar compared with mastectomy (RR 1.07, P=0.37). Adjuvant radiotherapy after mastectomy was associated with a lower risk for locoregional recurrence (RR 0.43, P<0.001) and death (RR 0.73, P=0.001). Patients with 1–3 positive nodes benefited the most from radiotherapy after mastectomy. Breast-conserving therapy was associated with an impaired locoregional control. However, breast-conserving therapy was not associated with a worse overall survival. Adjuvant radiotherapy in mastectomised patients was associated with both a significantly superior locoregional control and overall survival. The effect of adjuvant radiotherapy was most profound in patients who had 1–3 positive nodes.