Top

Published in:

01-02-2010 | Review

Loco-regional treatment in metastatic breast cancer patients: Is there a survival benefit?

Authors: Bevan H. Ly, Nam P. Nguyen, Vincent Vinh-Hung, Elisabetta Rapiti, Georges Vlastos

Published in: Breast Cancer Research and Treatment | Issue 3/2010

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.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics. CA Cancer J Clin 58(2):71–96CrossRefPubMed

Ries LAG, Melbert D, Krapcho M et al. (eds) SEER cancer statistics review, 1975–2004. National Cancer Institute, Bethesda. http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER Web site, 2007 gotten from the ACS Breast Cancer Facts

Biron P, Durand M, Roche H, Delozier T, Battista C, Fargeot P, Spaeth D, Bachelot T, Poiget E, Monnot F, Tanguy ML, Cure H (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 cancer. Bone Marrow Transplant 41:555–562CrossRefPubMed

Chuthapisit S, Eremin J, El-Sheemey M, Eremin O (2009) Breast cancer chemoresistance: emerging importance of cancer stem cells. Surg Oncol [Epub ahead of print]

Dean M, Fojo T, Bates S (2005) Tumor stem cells and drug resistance. Nat Rev Cancer 5:275–284CrossRefPubMed

Khan SA, Stewart AK, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132:620–626CrossRefPubMed

Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24:2743–2749CrossRefPubMed

Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE et al (2006) Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol 13:776–782CrossRefPubMed

Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA (2007) Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol 14:2187–2194CrossRefPubMed

10.

Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM (2008) Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg 247:732–738CrossRefPubMed

11.

Shien T, Kinoshita T, Shimizu C, Hojo T, Taira N, Doihara H, Akashi-Tanaka S (2009) Primary tumor resection improves the survival of younger patients with metastatic breast cancer. Oncol Rep 21:827–832PubMed

12.

Fields RC, Jeffe DB, Trinkaus K, Zhang Q, Arthur C, Aft R et al (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 metastasis. Ann Surg Oncol 14:3345–3351CrossRefPubMed

13.

Ruiterkamp J et al. (2009) Surgical resection of the primary tumor is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol. doi:10.1016/j.ejso.2009.03.012

14.

Hazard HW, Gorla SR, Scholtens D, Kiel K, Gradishar WJ, Khan SA (2008) Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer 113:2011–2019CrossRefPubMed

15.

Neuman H, Morrogh M, Gonen M, Van Zee K, Morrow M, King T (2008) Do patients with stage IV breast cancer and intact primary benefit from local control of the breast as a component of multimodality therapy? In: Breast cancer symposium, 5–7 Sept 2008. http://www.asco.org. Accessed 30 Sept 2008

16.

Badwe R, Hawaldar R, Khare A, Nadkarni M, Jalali R, Parmar V (2008) Role of local-regional treatment in metastatic breast cancer at presentation: a randomized trial. In: Breast cancer symposium, 5–7 Sept 2008. http://www.asco.org. Accessed 30 Sept 2008

17.

Le Scodan R, Stevens D, Brian E, Floiras JL, Cohen-Solal C, De La Lande B, Tubiana-Hulin M, Yacoub S, Gutierrez M, Ali D, Gardner M, Moisson P, Villette S, Lerebours F, Munck JN, Labib A (2009) Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. J Clin Oncol 27(9):1375–1381CrossRefPubMed

18.

Rao R, Feng L, Kuerer HM, Singletary E, Bedrosian I, Hunt KK, Ross MI, Hortobagyi GN, Feig BW, Ames FC, Babiera GV (2008) Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Ann Surg Oncol 15:1696–1702CrossRefPubMed

19.

Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD (2009) Effects of surgical excision on survival of patients with stage IV breast cancer. J Surg Res [Epub ahead of print]

20.

Bafford AC, Burstein HJ, Barkley CR et al (2009) Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat 115:7–12CrossRefPubMed

21.

Cady B, Nathan NR, Michaelson JS, Golshan M, Smith BL (2008) Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol 15:3384–3395CrossRefPubMed

22.

Carmicheal AR, Anderson EDC, Chetty U, Dixon JM (2003) Does local surgery have a role in the management of stage IV breast cancer? EJSO 29:17–19CrossRef

23.

Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, Caton JR Jr, Munshi N, Crawford ED (2001) Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345(23):1655–1659CrossRefPubMed

24.

Hallissey MT, Allum WH, Roginski C, Fielding JW (1988) Palliative surgery for gastric cancer. Cancer 62(2):440–444CrossRefPubMed

25.

Bristow RE, Tomacruz RS, Armstrong DK et al (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20(5):1248–1259CrossRefPubMed

26.

Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, Millis JM, Posner MC (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135(5):530–534CrossRefPubMed

27.

Young SE, Martinez SR, Essner R (2006) The role of surgery in treatment of stage IV melanoma. J Surg Oncol 94(4):344–351CrossRefPubMed

28.

Kakarala M, Wicha MS (2008) Implications of the cancer stem-cell hypothesis for breast cancer prevention and therapy. J Clin Oncol 26(17):2813–2820CrossRefPubMed

29.

Li X, Lewis MT, Huang J, Gutierrez C, Osborne CK, Wu MF, Hilsenbeck SG, Pavlick A, Zhang X, Chamness GC, Wong H, Rosen J, Chang JC (2008) Intrinsic resistance of tumorigenic breast cancer cells to chemotherapy. J Natl Cancer Inst 100(9):672–679CrossRefPubMed

30.

Liu R, Wang X, Chen GY, Dalerba P, Gurney A, Hoey T, Sherlock G, Lewicki J, Shedden K, Clarke MF (2007) The prognostic role of a gene signature from tumorigenic breast-cancer cells. NEJM 356(3):217–226CrossRefPubMed

31.

Li HZ, Yi TB, Wu YZ (2008) Suspension culture combined with chemotherapy agents for sorting of breast cancer stem cells. BMC Cancer 8:135CrossRefPubMed

32.

Cameron D, Casey M, Press M, Lindquist D, Pienkowski T, Romieu CC et al (2008) A phase III randomized comparison of lapatinib plus capecetabine versus capecetabine alone in women with advanced breast cancer that has progressed on trastuzumab: updated efficacy and biomarker analysis. Breast Cancer Res Treat 112:533–543CrossRefPubMed

33.

Atilla S, Serdar O, Sheryl KF, Bahadir GM (2009) Randomized trial comparing locoregional resection of primary tumor with no surgery in stage IV breast cancer at the presentation (protocol MF07-01): a study of Turkish federation of the national societies for breast. Breast J 15(4):399–403CrossRef

34.

Khan SA (2007) Does resection of an intact breast primary improve survival in metastatic breast cancer? Oncology 21(8):924–931PubMed

Title: Loco-regional treatment in metastatic breast cancer patients: Is there a survival benefit?
Authors: Bevan H. Ly
Nam P. Nguyen
Vincent Vinh-Hung
Elisabetta Rapiti
Georges Vlastos
Publication date: 01-02-2010
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2010
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-009-0610-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2010

Recommendations for research priorities in breast cancer by the Coalition of Cancer Cooperative Groups Scientific Leadership Council: systemic therapy and therapeutic individualization

A study of the effects of the aromatase inhibitors anastrozole and letrozole on bone metabolism in postmenopausal women with estrogen receptor-positive breast cancer

Derivation of molecular signatures for breast cancer recurrence prediction using a two-way validation approach

A phase II trial of trastuzumab plus weekly ixabepilone and carboplatin in patients with HER2-positive metastatic breast cancer: an Eastern Cooperative Oncology Group Trial

Elevated plasma endoglin (CD105) predicts decreased response and survival in a metastatic breast cancer trial of hormone therapy

Association of interleukin-10 gene variation with breast cancer prognosis

Keynote webinar | Spotlight on antibody–drug conjugates in cancer