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DOI: 10.1148/radiol.2351041723
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(Radiology 2005;235:339-340.)

Letters to the Editor

Hormone Receptor Status in Patients with Breast Cancer and Liver Metastases Treated with Laser-induced Intersititial Thermotherapy

Kadri Altundag, MD and Ozden Altundag, MD

Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey (current address: 8181 Fannin Street, Number 728, Houston, TX 77054) e-mail: altundag@sbcglobal.net

Paolo Morandi, MD

Department of Medical Oncology, S. Bortolo General Hospital, Vicenza, Italy

Mehmet Gunduz, MD, PhD

Department of Oral Pathology and Medicine, Graduate School of Medicine and Dentistry, Okayama University, Okayama, Japan

Editor:

We read with great interest the article by Dr Mack and colleagues in the November 2004 issue of Radiology (1) regarding the excellent local tumor control and survival rates achieved with laser-induced interstitial thermotherapy (LITT) in patients with breast cancer and liver metastases. With regard to the prognostic and predictive factors related to primary tumor, they found no statistically significant difference in terms of mean survival between the patients with N0–N1 lymph nodes and N2–N3 lymph nodes. However, they did not mention hormone receptor status of the patients, which might have an effect on the survival rate.

Elias et al (2) evaluated 54 patients with breast cancer and liver metastases as the sole site of metastatic disease (except for bone metastases in three patients) who underwent hepatectomy. They showed that the only factor influencing survival in both the uni- and multivariate analysis was the hormone receptor status (P = .03), and the relative risk of death was found to be increased by 3.5-fold when hormone receptor was negative. In light of this information, survival analysis in these patients treated with LITT according to hormone receptor status may further clarify the patients who benefit most from this specific type of therapy.

REFERENCES

  1. Mack MG, Straub R, Eichler K, Sollner O, Lehnert T, Vogl TJ. Breast cancer metastases in liver: laser-induced intersitital thermotherapy—local tumor control rate and survival data. Radiology 2004; 233:400-409.[Abstract/Free Full Text]
  2. Elias D, Maisonnette F, Druet-Cabanac M, et al. An attempt to clarify indications for hepatectomy for liver metastases from breast cancer. Am J Surg 2003; 185:158-164.[CrossRef][Medline]

Dr Mack and colleagues respond:

Martin G. Mack, MD, PhD, Ralf Straub, MD, Katrin Eichler, MD, Oliver Söllner, MD, Thomas Lehnert, MD and Thomas J. Vogl, MD, PhD

Department of Diagnostic and Interventional Radiology University Hospital Frankfurt, Johann Wolfgang Goethe-University Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany e-mail: m.mack@em.uni-frankfurt.de

First, we thank Dr Altundag and colleagues for their comments regarding our article (1). They pointed out that Elias et al (2) evaluated 54 patients with breast cancer and liver metastases and showed that the only factor influencing survival in both the uni- and multivariate analysis was the hormone receptor status.

In light of this information, we checked our patient population again with regard to hormone status and influence of hormone receptor status on the cumulative survival rate. As a result of referrals from many departments in Germany and Europe and the long inclusion period, we are not able to provide the hormone receptor status for all patients.

However, 105 of 232 patients (45.3%) had at least one positive hormone receptor status, 25 of 232 patients (10.8%) had negative hormone receptor status, and in 102 of 232 patients (43.9%), the hormone receptor status could not be obtained retrospectively.

Survival curves were evaluated by using the Kaplan-Meier method. There were statistically significant differences regarding the survival time for the different hormone receptor statuses, starting the calculation at the date of diagnosis of the metastases treated with LITT (log rank test, P = .007; Tarone Ware test, P = .001; and Breslow test, P < .002), as well as starting the calculation after the first LITT treatment (log rank test; P < .016; Tarone Ware test, P < .002; and Breslow test, P < .004).

The mean survival in patients with positive hormone receptor status was 5.5 years (95% confidence interval [CI]: 4.8 years, 6.3 years; median survival, 4.7 years), starting the calculation at the date of diagnosis of the metastases treated with LITT. The mean survival in patients with negative hormone receptor status was 3.7 years (95% CI: 2.8 years, 4.6 years; median survival, 5.1 years). The mean survival in patients with unclear hormone receptor status was 4.1 years (95% CI: 3.4 years, 4.8 years; median survival, 3.1 years).

The mean survival in patients with positive hormone receptor status was 4.1 years (95% CI: 3.5 years, 4.7 years; median survival, 4.6 years), starting the calculation after the first LITT treatment. The mean survival in patients with negative hormone receptor status was 3.2 years (95% CI: 2.3 years, 4.2 years; median survival, 5.0 years). The mean survival in patients with unclear hormone receptor status was 3.7 years (95% CI: 2.9 years, 4.5 years; median survival, 2.0 years).

In concordance with the findings of Elias et al (2), we also found that the hormone receptor status is a significant (P < .05) prognostic factor on both mean and median survival.

REFERENCES

  1. Mack MG, Straub R, Eichler K, Sollner O, Lehnert T, Vogl TJ. Breast cancer metastases in liver: laser-induced intersitital thermotherapy—local tumor control rate and survival data. Radiology 2004; 233:400-409.
  2. Elias D, Maisonnette F, Druet-Cabanac M, et al. An attempt to clarify indications for hepatectomy for liver metastases from breast cancer. Am J Surg 2003; 185:158-164.




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Right arrow Articles by Vogl, T. J.

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