Volume 4, Issue 2, March 2016, Page: 32-36
The Benefit of Locoregional Surgical Intervention in Metastatic Breast Cancer at Initial Presentation
Niveen A. Abo-Touk, Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Amir A. Fikry, Departement of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
El Yamani Fouda, Departement of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Received: Feb. 19, 2016;       Accepted: Feb. 28, 2016;       Published: Mar. 12, 2016
DOI: 10.11648/j.crj.20160402.12       View        Downloads  
This study aims to determine the value of locoregional surgery compared with no surgery on the outcome of women with metastatic breast cancer at initial presentation. For that, fifty seven patients initially presented with stage IV breast cancer were prospectively randomized to undergo mastectomy in group I (27 patients) or no surgery in group II (30 patients). All patients received systemic treatment including chemotherapy, hormonal treatment in receptor positive patients and palliative radiotherapy for patients with bone metastases .The median overall survival (OS) was 18 and 11 months in group I and II, respectively; however the difference did not reach statistical significant (p=0.085). The 2-year OS was 46% in group I and 22% in group II. Tumor size, clinical lymph node stage, Eastern Cooperative Oncology Group Performance Status (ECOG- PS) and the number of metastatic sites were significant independent prognostic factors affecting the OS in univariate analysis, and bone metastases was highly statistically significant. In multivariate analysis ECOG- PS was a significant factor and both the number of metastatic sites and bone metastases were highly significant. Although, locoregional surgery tends to increase overall survival in patients presented with metastatic breast cancer and patients with better ECOG- PS and single bone metastasis are more likely to benefit from surgery, further studies are needed involving a large number of cases, multi-institutional trials and longer follow-up to verify these findings.
Breast Cancer, Metastasis, Locoregional Treatment, Surgery
To cite this article
Niveen A. Abo-Touk, Amir A. Fikry, El Yamani Fouda, The Benefit of Locoregional Surgical Intervention in Metastatic Breast Cancer at Initial Presentation, Cancer Research Journal. Vol. 4, No. 2, 2016, pp. 32-36. doi: 10.11648/j.crj.20160402.12
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cardoso F, Harbeck N, Fallowfield L, Kyriakides S, Senkus E. Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology: official journal of the European Society for Medical Oncology / ESMO. 2012; 23 Suppl 7:vii11-9. doi:10.1093/annonc/mds232.
Dawood S, Broglio K, Ensor J, Hortobagyi GN, Giordano SH. Survival differences among women with de novo stage IV and relapsed breast cancer. Annals of oncology: official journal of the European Society for Medical Oncology / ESMO. 2010; 21(11):2169-74. doi:10.1093/annonc/mdq220.
Andre F, Slimane K, Bachelot T, Dunant A, Namer M, Barrelier A et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2004; 22(16):3302-8. doi:10.1200/jco.2004.08.095.
Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988-2003 SEER data. Annals of surgical oncology. 2007; 14(8):2187-94. doi: 10.1245/s10434-007-9438-0.
Ruiterkamp J, Ernst MF, van de Poll-Franse LV, Bosscha K, Tjan-Heijnen VC, Voogd AC. Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2009; 35(11):1146-51. doi:10.1016/j.ejso.2009.03.012.
Khan SA, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery. 2002; 132(4):620-6; discussion 6-7.
Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2006; 24(18):2743-9. doi:10.1200/jco.2005.04.2226.
Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. The Lancet Oncology. 2015; 16(13):1380-8. doi: 10.1016/s1470-2045(15)00135-7.
Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A et al. Abstract S2-03: Early follow up of a randomized trial evaluating resection of the primary breast tumor in women presenting with de novo stage IV breast cancer; Turkish study (protocol MF07-01). Cancer research. 2013; 73(24 Supplement):S2-03. doi:10.1158/0008-5472.sabcs13-s2-03.
Fisher B. Biological and clinical considerations regarding the use of surgery and chemotherapy in the treatment of primary breast cancer. Cancer. 1977; 40(1 Suppl): 574-87.
Cristofanilli M, Hayes DF, Budd GT, Ellis MJ, Stopeck A, Reuben JM et al. Circulating tumor cells: a novel prognostic factor for newly diagnosed metastatic breast cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2005; 23(7): 1420-30. doi: 10.1200/jco.2005.08.140.
Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM. Association of surgery with improved survival in stage IV breast cancer patients. Annals of surgery. 2008; 247(5):732-8. doi:10.1097/SLA.0b013e3181656d32.
McGuire KP, Eisen S, Rodrigu ez A, Meade T, Cox CE, Khakpour N. Factors associated with improved outcome after surgery in metastatic breast cancer patients. American journal of surgery. 2009; 198(4):511-5. doi:10.1016/j.amjsurg.2009.06.011.
Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Annals of surgical oncology. 2006; 13(6):776-82. doi:10.1245/aso.2006.03.033.
Neuman HB, Morrogh M, Gonen M, Van Zee KJ, Morrow M, King TA. Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer. 2010; 116(5):1226-33. doi:10.1002/cncr.24873.
Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD. Effects of surgical excision on survival of patients with stage IV breast cancer. The Journal of surgical research. 2010; 161(1):83-8. doi:10.1016/j.jss.2008.12.030.
Nguyen DH, Truong PT, Alexander C, Walter CV, Hayashi E, Christie J et al. Can locoregional treatment of the primary tumor improve outcomes for women with stage IV breast cancer at diagnosis? International journal of radiation oncology, biology, physics. 2012; 84(1):39-45. doi:10.1016/j.ijrobp.2011.11.046.
Rhu J, Lee SK, Kil WH, Lee JE, Nam SJ. Surgery of primary tumour has survival benefit in metastatic breast cancer with single-organ metastasis, especially bone. ANZ journal of surgery. 2015; 85(4):240-4.
Bafford AC, Burstein HJ, Barkley CR, Smith BL, Lipsitz S, Iglehart JD et al. Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast cancer research and treatment. 2009; 115(1):7-12. doi: 10.1007/s10549-008-0101-7.
Badwe R, Parmar V, Hawaldar R. Surgical removal of primary tumor and axillary lymph nodes in women metastatic breast cancer at first presentation: A randomized controlled trial San Antonio Breast Cancer Symposium. Abstract S2-02. Presented December 11, 2013. 2013.
Fisher B, Gunduz N, Coyle J, Rudock C, Saffer E. Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer research. 1989; 49(8):1996-2001.
Özmen V. After the San Antonio Breast Cancer Symposium 2013. 2014.
Lee T, Isaacs C. Treatment of primary breast tumors in de novo metastatic breast cancer. Clinical advances in hematology & oncology: H&O. 2014; 12(12):820-7.
Browse journals by subject