Outcomes After Palliative Radiation Therapy in Patients With Symptomatic Locoregionally Advanced Breast Cancer

Luisa E Jacomina; David M Swanson; Melissa P Mitchell; Wendy A Woodward; Benjamin D Smith; Karen E Hoffman; Chelain R Goodman; Haven R Garber; Susie X Sun; Timothy A Yap; Funda Meric-Bernstam; Isidora Y Arzu; Elizabeth S Bloom; Pamela J Schlembach; Eric A Strom; Michael C Stauder; Simona F Shaitelman

doi:10.1016/j.ijrobp.2024.11.065

Outcomes After Palliative Radiation Therapy in Patients With Symptomatic Locoregionally Advanced Breast Cancer

Int J Radiat Oncol Biol Phys. 2024 Nov 15:S0360-3016(24)03637-X. doi: 10.1016/j.ijrobp.2024.11.065. Online ahead of print.

Authors

Luisa E Jacomina¹, David M Swanson², Melissa P Mitchell³, Wendy A Woodward³, Benjamin D Smith³, Karen E Hoffman⁴, Chelain R Goodman³, Haven R Garber⁵, Susie X Sun⁶, Timothy A Yap⁷, Funda Meric-Bernstam⁷, Isidora Y Arzu⁸, Elizabeth S Bloom⁸, Pamela J Schlembach⁸, Eric A Strom³, Michael C Stauder³, Simona F Shaitelman³

Affiliations

¹ Departments of Radiation Oncology; Breast Radiation Oncology. Electronic address: [email protected].
² Departments of Radiation Oncology; Biostatistics.
³ Breast Radiation Oncology.
⁴ Breast Radiation Oncology; Genitourinary Radiation Oncology.
⁵ Breast Medical Oncology.
⁶ Breast Surgical Oncology.
⁷ Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁸ Departments of Radiation Oncology; Breast Radiation Oncology.

PMID: 39549757
DOI: 10.1016/j.ijrobp.2024.11.065

Abstract

Purpose: Symptomatic locoregionally advanced breast cancer (SLABC) can cause troublesome pain or wound complications that negatively impact quality of life. Although palliative radiation therapy (RT) can minimize tumor-related symptoms, how best to tailor RT to achieve the most meaningful and durable response is not well defined.

Methods and materials: This is a single institution, multi-site retrospective review of patients with SLABC treated between 2016 and 2023 with palliative RT to symptomatic disease in the breast, chest wall, and/or regional lymph node basins. Overall survival (OS), locoregional control (LC), clinical and radiographic treatment response, overall pain scores, and treatment-related toxicities were analyzed.

Results: A total of 164 patients with a median age of 57 years were analyzed with a median follow-up time of 4.97 months. In total, 86% had distant metastases. The most common presenting symptom was pain (87%), followed by ulcerating or fungating lesion (76%) and discharge (45%). The median cumulative biologically effective dose to the gross tumor volume (BED_GTV) was 69 Gy. The 1-year OS and LC rates were 37% and 63%, respectively. Eighty-one percent experienced improvement in symptoms within 3 months after RT, the odds of which increased per Gy BED_GTV (odds ratio, 1.029; P = .003). Acute toxicities were associated with number of fractions and BED_GTV (both P < .001), but not with concurrent systemic therapy or reirradiation (both P > .05). Trends in pain scores showed a significant change in pain trajectory that was sustained during the first year after RT. OS and LC were not different among patients who received 1 versus 2 to 10 versus >10 fractions, and between ≤70 and >70 Gy BED_GTV.

Conclusions: In this large series of patients with SLABC, palliative RT was effective at relieving locoregional symptoms with acceptable toxicity, with the likelihood of symptom improvement associated with radiation dose. Survival of these patients remains poor, highlighting the importance of palliative care strategies that minimize overall symptom burden while maximizing quality of life.