Loco-regional treatment in metastatic breast cancer patients: Is there a survival benefit?
- 30 October 2009
- journal article
- review article
- Published by Springer Science and Business Media LLC in Breast Cancer Research and Treatment
- Vol. 119 (3), 537-545
- https://doi.org/10.1007/s10549-009-0610-z
Abstract
A number of studies have recently demonstrated a survival benefit in stage IV breast cancer patients following surgical resection of the primary tumor. Here, we investigate the relationship between loco-regional treatment and survival in patients with metastatic breast cancer and evaluate the impact of different loco-regional treatments. We conducted a systematic review of the literature using PubMed to analyze studies with the following criteria: Type of loco-regional treatment (surgery alone or combined with radiation, radiotherapy), overall survival, progression-free survival, selection factors for local treatment, and complication rates. Thirteen studies evaluated the effect of loco-regional treatment on overall survival with overall median survival increasing from a range of 12.6–28.3 months among patients without surgery to a range of 25–42 months among patients with surgery. In addition, six studies reported a 3-year survival benefit of 28–95% and 17–79% in women with and without loco-regional therapy respectively. Two studies did not find any improvement in overall survival. One study found an improvement in 5-year breast cancer-specific survival of 27% with negative surgical margins versus 12% with no surgery. Three studies reported an advantage in progression-free survival in the treatment group compared with the non-treatment group. Loco-regional treatment for breast cancer patients with distant metastases at diagnosis is an important issue because of possible improvement of survival or disease-free survival. The possibility of surgery and/or radiotherapy following induction chemotherapy should be weighed and left to individual practice. Participation in randomized controlled trials should be encouraged.Keywords
This publication has 29 references indexed in Scilit:
- Breast cancer chemoresistance: Emerging importance of cancer stem cellsSurgical Oncology, 2010
- Association of Surgery With Improved Survival in Stage IV Breast Cancer PatientsAnnals of Surgery, 2008
- Cancer Statistics, 2008CA: A Cancer Journal for Clinicians, 2008
- Pegase 03: a prospective randomized phase III trial of FEC with or without high-dose thiotepa, cyclophosphamide and autologous stem cell transplantation in first-line treatment of metastatic breast cancerBone Marrow Transplantation, 2007
- Surgical Resection of the Primary Tumor is Associated with Increased Long-Term Survival in Patients with Stage IV Breast Cancer after Controlling for Site of MetastasisAnnals of Surgical Oncology, 2007
- Surgical Removal of the Primary Tumor Increases Overall Survival in Patients With Metastatic Breast Cancer: Analysis of the 1988–2003 SEER DataAnnals of Surgical Oncology, 2007
- Complete Excision of Primary Breast Tumor Improves Survival of Patients With Metastatic Breast Cancer at DiagnosisJournal of Clinical Oncology, 2006
- Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary TumorAnnals of Surgical Oncology, 2006
- Tumour stem cells and drug resistanceNature Reviews Cancer, 2005
- Does aggressive local therapy improve survival in metastatic breast cancer?Surgery, 2002