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Metastatic Breast Cancer Treatment and Survival Strategies

Learn about local treatment options for oligometastatic breast cancer patients, including surgery and liver metastasectomy. Understand the role of occult tumors, genes, and survival rates in metastatic breast cancer. Discover ideal candidates and procedures for lung and bone metastasis resection. Explore the impact of treatments on survival and quality of life.

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Metastatic Breast Cancer Treatment and Survival Strategies

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  1. Partiële lever resectie gaat gepaard met een postoperatieve mortaliteit van :A:  < 1 %B:  5-10 %C:  >10 % Hersenmetastasen CT

  2. De vijf jaars overleving bij een volledige resectie van een solitaire longmetastase isA:  <10 %B:  10-30 %C:  >30 % Hersenmetastasen CT

  3. Prof Herman Depypere, Dr A Dierickx, Drs C Vertriest, prof R Vandenbroecke, prof Troisy, prof Cocquyt Breast and Menopause Clinic, University Hospital, Gent, Belgium LOKALE BEHANDELING VAN DE OLIGOGEMETASTASEERDE PATIENTE

  4. Vrouwen Mannen

  5. biomedische les hormonen en kanker-2012- Prof Depypere -Prof Bracke

  6. Occult Breast Tumor Reservoir • 7-15.6 % have undiagnosed breast cancer at autopsy • Mammographic detection threshold 0.88-1.66 cm • Doubling times between 10-700 days • Santens model (200 days doubling time, 1.16 cm detection, 7 % prevalence) Santen R et al. Horm canc, 2013; Santen R J of steroid biochemistry and molecular biology 2013.

  7. For women older than 40 (Bailey et al.) the doubling time of tumors is 200 days (detection of 0.88 cm) only 6 % of de novo tumors would be detected after 7 years. So the majority of tumors detected were pre existing occult tumors.

  8. CANCER PROGRESSION Tumor/Invasion- promotor and -suppressor genes Metastasic promotor genes? early?

  9. Metastasis: Early OCCULT TUMOR CELLS (OTC) IN LYMPH NODES AND BONE MARROW Breast cancer, pT1-2 N0 M0 (n=484) Lymph node 6.4 % Bone Marrow 26.0 % Both 4.8 % Total 37.2 % Gerber et al., J Clin Oncol 19: 960. 2001

  10. Promoter Genes Implicated in Invasion and Metastasis How many? Many! ErbB2 HER-2 Neu Oliveira et al.,2004

  11. 1991

  12. 2005

  13. Suppressor Genes Implicated in Invasion and Metastasis How many? Many! CDH1 Oliveira et al.,2004

  14. 15

  15. MBC up till now considered as uncurable disease and treated with chemo/hormonal/immuno/radiotherapy. Aim palliation and prolongation of live. Surgery was used for palliation in symptomatic patients with bone or brain metastasis or to prevent fractures in bonemetastasis. Metastasectomy has been successfully in patients with colorectal cancer, osteosarcoma, renalcel cancer, melanoma and germcel cancer.

  16. Currently, candidatesforresection/treatment of metastaticlocations are: Patientswitholigometastasis Patientswithmetastasisthatrespondwellonsystemictherapy Resectablelocation/tissue

  17. Livermetastasis Echography ct scan/pet scan Mri biopsy

  18. Echografie lever

  19. Levermetastasen CT

  20. Levermetastase van mammaca

  21. PETCT borsttumor en levermetastase

  22. Studies report a median survival of MBC patients after liver metastasectomy between 27 and 63 months. Postoperative mortality is 0 %. Idealcandidateforresection of livermetastase(s)s of breastcancer: Young age Hormone sensitive breastcancer DFI ≥1 year Goodpreoperative respons onchemotherapy < 4 liver metastases Normalliverfunction tests noextrahepaticdisease (exceptbone metastases) RO resection

  23. lungmetastasis Rx thorax Ct scan biopsy

  24. RX thorax pleuravocht

  25. CT longmetastasen

  26. Aspecifieke micronodules

  27. CT-geleide biopsie longmetastase, postbiopsie hemorragie postbiopsie hemorragie

  28. 15-25% of MBC patients have metastases isolated in the lung or pleura. The median survival in these patients is 19 to 22 months with a 10-year survival of 9% with chemotherapy. The ‘International registry of lung metastases’ was founded to study the long term results of pulmonary metastasectomy in different cancers. The 5-years survival of 36% was observed in 4572 patients with a R0 resection. After 15 years 22% of patients were still alive. In little under 1/4 of metastatic patients surgery may be curative.

  29. Idealcandidatesforresection of longmetastases in breastcancer are: DFI≥36 months R0 resection number (<2) Size (<3cm)

  30. Hersenmetastasen CT • Meimarakis et al. (2013) performed a prospective trial in 81 MBC patients who underwent a ressection of longmetastasis. • In their study other factors were included: • size of metastase (mediane survival if metastase <3cm: 103.4 months versus 39.1 months if >3cm) • hormone receptor positivity (median survival if positive 127 months versus 27 months if negative • Reported mortality after resection of lung metastasis is 0-1% , the morbidity is 0-13% in different studies.

  31. In instances of recurrence: resect again

  32. Bone metastases Palliative setting : main indication Avoid fracture Releave of pain Survival influence Cure ?

  33. Bone metastasis BONE SCAN RX BONE MR

  34. Botmetastasen van ovariumcarcinoom

  35. PET-CT mammacarcinoom

  36. RX en MR botmetastasen

  37. RX en CT botmetastase Plain Film > 50% change BMD < 18m later than Tc-scan CT also finds lytic lesions

  38. Botscintigrafie

  39. Cervicale botmetastase T2 CT

  40. CT geleide biopsie ribletsel, hotspot op botscan, bij mammaca

  41. CT-geleide biopsie lytisch botletsel pathologische fractuur

  42. Solitary humerus metastasis

  43. Bone metastases Most frequent localtions are spine, femur, ribs, sternum, humerus. 20 % isolatedlocations. Cause pain. Dangerforcordcompression . Apart fromsystemictherapyradiotherapy is given. Radiotherapyinducescallusformation and stabilizes the lytic zone. 33-50 % is pain free. Recent publication(Wegener et al. 2012) mediane survival of solitarybonemetastasis is 65 months. Prognostic factors: R0 resection, abscence of visceralmetastasis. Surgerywithintent to cure had a positiveinfluenceon survival.

  44. BRAIN METASTASIS Hersenmetastasen CT

  45. BRAIN METASTASIS Diagnosis by PET SCAN/MRI Cause headage, nausea, cognitive disorders, epilepsy. Present 6 - 16% of MBC patients. In autopsy of MBC patients brain metastasis is present in 30%. The incidence is higher in triple negative breast cancers, in tumors with Her2Neu oncogen expression and in tumors with high Ki-67. Whole brain radiation improves symptoms Fast recurrence 1/3 only location Several studies observe better out come when surgery is added to WBR. Leptomeningeal metastasis very poor outcome.

  46. In 40 % of womenwithbreast cancer metastatic disease will develop, in 5 % dedectable metastasis will be present at initial diagnosis. Ruiterkamp J, Ernst MF. The role of surgery in metastatic breast cancer. Eur J Cancer.2011 Sep;47 Suppl 3:S6-22. Singletary SE, Walsh G, Vauthey JN, Curley S, Sawaya R, Weber KL, Meric F, Hortobágyi GN. Oncologist. 2003;8(3):241-51.

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