Stereotactic body radiotherapy to treat breast cancer oligometastases: A systematic review with meta-analysis

Objectives: Stereotactic ablative radiotherapy (SABR) has been reported to be an effective treatment for oligometastatic disease from different primary cancer sites. Here we assess the effectiveness and safety of SABR for oligometastatic breast cancer patients by performing a meta-analysis. Methods: Following PRISMA and MOOSE guidelines, a systematic review and meta-analysis was per-formed. Eligible studies were identified on Medline, Embase, Cochrane Library, and annual meetings pro-ceedings from 1990 to June 2021. A meta-regression analysis was performed to assess if there was a correlation between moderator variables and outcomes, and a p-value <0.05 was considered significant. Results: Ten studies met criteria for inclusion, comprising 467 patients and 653 treated metastases. The 1-and 2-year local control rates were 97% (95% CI 95-99%), and 90% (95% CI 84-94%), respectively. Overall survival (OS) was 93% (95% CI 89-96%) at 1 year, 81% (95% CI 72-88%) at 2 years. The rate of any grade 2 or 3 toxicity was 4.1 % (95% CI 0.1-5%), and 0.7% (0-1%), respectively. In the meta-regression analysis, only prospective design (p = 0.001) and bone-only metastases (p = 0.01) were signif-icantly associated with better OS. In the subgroup analysis, the OS at 2y were significantly different com-paring HER2+, HR+/HER2(-) and triple negative breast cancer 100%, 86% and 32%, p = 0.001. For local control outcomes, hormone receptor status (p = 0.01) was significantly associated on meta-regression analysis. Conclusion: SABR for oligometastatic breast cancer is safe and associated with high rates of local control. Longer follow-up of existing data and ongoing prospective trials will help further define the role of this management strategy. (c) 2021 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 164 (2021) 245-250

Automated summary

SABR for oligometastatic breast cancer is safe and effective, with high rates of local control and survival. Prospective design and bone-only metastases are significantly associated with better outcomes.