Amy Marie Fowler MD, PhD, Presenter: Nothing to Disclose

Stephanie Markovina MD, PhD, Abstract Co-Author: Nothing to Disclose

Angela Hirbe, Abstract Co-Author: Nothing to Disclose

Christina Koo Speirs MD, PhD, Abstract Co-Author: Nothing to Disclose

Alejandro Munoz Del Rio PhD, Abstract Co-Author: Research Consultant, Cellectar Biosciences, Inc Reviewer, Wolters Kluwer nv

Todd DeWees, Abstract Co-Author: Nothing to Disclose

Cynthia Ma, Abstract Co-Author: Nothing to Disclose

Jeffrey R. Olsen MD, Abstract Co-Author: Consultant, DFINE, Inc Travel support, DFINE, Inc Speaker, ViewRay, Inc

Nael El Said Saad MBBCh, Abstract Co-Author: Research Consultant, Veran Medical Technologies, Inc Proctor, Sirtex Medical Ltd

To determine the clinical outcomes for breast cancer patients with chemorefractory liver metastases treated with locoregional therapy.

This HIPAA-compliant, IRB-approved study is a single-institution, retrospective chart review. Twenty-nine consecutive female breast cancer patients (mean age 55 years; 35-77) with unresectable liver metastases progressing despite systemic chemotherapy were included who were treated with radiofrequency (RF) ablation (n=7), chemoembolization (n=6), or 90Y radioembolization (n=16) from January 1999 to March 2013. Follow-up data was obtained through June 2013. Treatment response was evaluated on follow-up imaging which consisted of CT, MRI, and/or PET/CT. Overall survival (OS) time and time to progression (TTP) of disease was measured from the time of first liver-directed therapy. OS and TTP curves were generated using the Kaplan-Meier method and compared with the log rank test.

Median OS was 21 months (1-81 months) for all patients and was 34, 15.5, and 16 months for patients treated with RF ablation, chemoembolization, and radioembolization, respectively. Longer OS was measured for those treated with RF ablation compared to chemoembolization (p=0.04) or radioembolization (p=0.03). Median follow-up was 16 months (1-81 months) with one death from liver failure prior to follow-up imaging. Median TTP was 4 months (1-26 months) for all patients and was 2, 1, and 6 months for patients treated with RF ablation, chemoembolization, and radioembolization, respectively. Longer TTP was measured for patients treated with radioembolization compared to RF ablation (p=0.04).

Survival was comparable for patients treated with chemo- and radioembolization, but was prolonged for those treated with RF ablation, presumably from reduced pre-therapy disease burden.

While this study is small with a heterogeneous retrospective cohort, the results support a palliative indication for radio- and chemoembolization with potential prolonged survival provided by RF ablation. Identification of patient and tumor biomarker criteria that best predict survival and consideration of earlier utilization of embolization at lower amounts of disease burden may improve outcomes. A matched-pair analysis with patients treated with systemic chemotherapy alone is in progress.

Fowler, A, Markovina, S, Hirbe, A, Speirs, C, Munoz Del Rio, A, DeWees, T, Ma, C, Olsen, J, Saad, N, Liver-Directed Therapy for Metastases from Breast Cancer: Outcomes Analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001564.html