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Ten-year experience of bone SBRT in breast cancer: analysis of predictive factors of effectiveness

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Abstract

Purpose

Data on the benefit of stereotactic body radiation therapy (SBRT) in patients with breast cancer (BC) and bone metastases remain limited. The purpose of this study is to report our 10-year experience of bone SBRT, analyzing toxicity and prognostic factors for local control (LC); progression-free survival, and overall survival (OS).

Methods/patients

We analyzed all spine and non-spine bone SBRT performed in patients with BC during the 2012–2022 period at our institution. Treatments carried out with ablative intent in stereotactic conditions with dose/fraction ≥ 5 Gy in 5 or fewer sessions were considered. Demographic, treatment, and toxicity data were recorded according to CTCAEv4. Risk factors were assessed through univariate and multivariate analysis by Cox regression.

Results

60 bone SBRT treatments were performed during the study period. 75% were spine SBRT and 25% were non-spine SBRT (median BED4Gy was 80 Gy4). The median age was 52.5 years (34–79). The median tumor volume was 2.9 cm3 (0.5–39.4). The median follow-up was 32.4 months (1.2–101.7). 1 and 2 years LC were 92.9 and 86.6%, respectively. 1 and 2 years OS were 100 and 90.6%, respectively. Multivariate analysis (MVA) associated volume of the treated lesion ≥ 13 cm3 with worse LC (p = 0.046; HR 12.1, 95%CI = 1.1–140.3). In addition, deferring SBRT > 3 months after lesion diagnosis to prioritize systemic treatment showed a significant benefit, improving the 2 years LC up to 96.8% vs. 67.5% for SBRT performed before this period (p = 0.031; HR 0.1, 95%CI = 0.01–0.8). Hormonal receptors, the total number of metastases, and CA15-3 value were significantly associated with OS in MVA. During follow-up, three non-spine fractures (5%) were observed.

Conclusions

According to our data, bone SBRT is a safe and effective technique for BC. Upfront systemic treatment before SBRT offers a benefit in LC. Therefore, SBRT should be considered after prior systemic treatment in this population.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Data code

All data and materials as well as the software application or custom code support their published claims and comply with field standards.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l’Hospitalet, L’Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain

    Héctor Pérez-Montero, Alicia Lozano, Evelyn Martínez, María Laplana, Ferrán Guedea & Arturo Navarro-Martin

  2. Medical Physics and Radiation Protection Department, Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l’Hospitalet, L’Hospitalet de Llobregat, 199-203, 08908, Barcelona, Spain

    Rodolfo de Blas

  3. Radiodiagnostic Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain

    Juan José Sánchez

  4. Medical Oncology Department, Radiation Oncology Department, Catalan Institute of Oncology, Avinguda de la Gran Via de l’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908, Barcelona, Spain

    Miguel Gil-Gil, Sonia Pernas & Catalina Falo

  5. Gynecology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain

    Amparo Garcia-Tejedor & Maria J. Pla

  6. Neurosurgery Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Carrer de la Feixa Llarga, S/N, 08907, Barcelona, Spain

    Óscar Godino

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  1. Héctor Pérez-Montero
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Contributions

HP-M, AL and AN-M: contributed to the study conception and design. Data collection, analysis, and interpretation were performed by HP-M and AN-M. HP-M, AN-M, AL, RB, JJS, ML, EM, MG-G, CF, AG-T, SP, OG and MJP: are physicians or medical physicists who contributed in the treatment and/or follow-up of the cases. The first draft of the manuscript was written by HP-M and AN-M. All authors revised critically and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Arturo Navarro-Martin.

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Conflict of interest

Miguel Gil-Gil has received personal fees from Pfizer, Daiichi Sankyo, Novartis, Gilead, AstraZeneca, and Roche. These fees are not related to this study. The rest of the authors have no relevant financial or non-financial interests to disclose. The authors alone are responsible for the content and writing of the paper.

Ethics approval

All procedures were performed under the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval for this study was granted by the Ethics Committee of Hospital Universitari de Bellvitge (15.06.2021/PR224/21).

Consent to participate

For this type of study, formal consent is not required. The patients did not receive any specific informed consent as data were collected from a retrospective review of electronic medical records. The patients signed the informed consent for the usual procedure.

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Pérez-Montero, H., Lozano, A., de Blas, R. et al. Ten-year experience of bone SBRT in breast cancer: analysis of predictive factors of effectiveness. Clin Transl Oncol 25, 1756–1766 (2023). https://doi.org/10.1007/s12094-023-03073-0

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