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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2010

01-09-2010 | Breast Oncology

Metastasectomy and Surgical Resection of the Primary Tumor in Patients With Stage IV Breast Cancer

Time for a Second Look?

Authors: Barbara A. Pockaj, MD, Nabil Wasif, MD, Amylou C. Dueck, PhD, Dennis A. Wigle, MD, Judy C. Boughey, MD, Amy C. Degnim, MD, Richard J. Gray, MD, Sarah A. McLaughlin, MD, Donald W. Northfelt, MD, Robert P. Sticca, MD, James W. Jakub, MD, Edith A. Perez, MD

Published in: Annals of Surgical Oncology | Issue 9/2010

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Abstract

Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.
Literature
1.
Greenberg PA, Hortobagyi GN, Smith TL, Ziegler LD, Frye DK, Buzdar AU. Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol. 1996;14:2197–205.PubMed
2.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.CrossRefPubMed
3.
Robertson DJ, Stukel TA, Gottlieb DJ, Sutherland JM, Fisher ES. Survival after hepatic resection of colorectal cancer metastases: a national experience. Cancer. 2009;115:752–9.CrossRefPubMed
4.
Wolpin BM, Mayer RJ. Systemic treatment of colorectal cancer. Gastroenterology. 2008;134:1296–310.CrossRefPubMed
5.
Rivera E, Holmes FA, Buzdar AU, Asmar L, Kau SW, Fraschini G, et al. Fluorouracil, doxorubicin, and cyclophosphamide followed by tamoxifen as adjuvant treatment for patients with stage IV breast cancer with no evidence of disease. Breast J. 2002;8:2–9.CrossRefPubMed
6.
Clark GM, Sledge GW Jr, Osborne CK, McGuire WL. Survival from first recurrence: relative importance of prognostic factors in 1,015 breast cancer patients. J Clin Oncol. 1987;5:55–61.PubMed
7.
Insa A, Lluch A, Prosper F, Marugan I, Martinez-Agullo A, Garcia-Conde J. Prognostic factors predicting survival from first recurrence in patients with metastatic breast cancer: analysis of 439 patients. Breast Cancer Res Treat. 1999;56:67–78.CrossRefPubMed
8.
Goldhirsch A, Gelber RD, Castiglione M. Relapse of breast cancer after adjuvant treatment in premenopausal and perimenopausal women: patterns and prognoses. J Clin Oncol. 1988;6:89–97.PubMed
9.
Wyld L, Gutteridge E, Pinder SE, James JJ, Chan SY, Cheung KL, et al. Prognostic factors for patients with hepatic metastases from breast cancer. Br J Cancer. 2003;89:284–90.CrossRefPubMed
10.
Raab R, Nussbaum KT, Behrend M, Weimann A. Liver metastases of breast cancer: results of liver resection. Anticancer Res. 1998;18:2231–3.PubMed
11.
Seifert JK, Weigel TF, Gonner U, Böttger TC, Junginger T. Liver resection for breast cancer metastases. Hepatogastroenterology. 1999;46:2935–40.PubMed
12.
Selzner M, Morse MA, Vredenburgh JJ, Meyers WC, Clavien PA. Liver metastases from breast cancer: long-term survival after curative resection. Surgery. 2000;127:383–9.CrossRefPubMed
13.
Yoshimoto M, Tada T, Saito M, Takahashi K, Uchida Y, Kasumi F. Surgical treatment of hepatic metastases from breast cancer. Breast Cancer Res Treat. 2000;59:177–84.CrossRefPubMed
14.
Pocard M, Pouillart P, Asselain B, Falcou MC, Salmon RJ. [Hepatic resection for breast cancer metastases: results and prognosis (65 cases)]. Ann Chir. 2001;126:413–20 (French).
15.
Carlini M, Lonardo MT, Carboni F, Petric M, Vitucci C, Santoro R, et al. Liver metastases from breast cancer: results of surgical resection. Hepatogastroenterology. 2002;49:1597–601.PubMed
16.
Elias D, Maisonnette F, Druet-Cabanac M, Ouellet JF, Guinebretiere JM, Spielmann M, et al. An attempt to clarify indications for hepatectomy for liver metastases from breast cancer. Am J Surg. 2003;185:158–64.CrossRefPubMed
17.
Vlastos G, Smith DL, Singletary SE, Mirza NQ, Tuttle TM, Popat RJ, et al. Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic metastases. Ann Surg Oncol. 2004;11:869–74.CrossRefPubMed
18.
Sakamoto Y, Yamamoto J, Yoshimoto M, Kasumi F, Kosuge T, Kokudo N, et al. Hepatic resection for metastatic breast cancer: prognostic analysis of 34 patients. World J Surg. 2005;29:524–7.CrossRefPubMed
19.
d’Annibale M, Piovanello P, Cerasoli V, Campioni N. Liver metastases from breast cancer: the role of surgical treatment. Hepatogastroenterology. 2005;52:1858–62.PubMed
20.
Ercolani G, Grazi GL, Ravaioli M, Ramacciato G, Cescon M, Varotti G, et al. The role of liver resections for noncolorectal, nonneuroendocrine metastases: experience with 142 observed cases. Ann Surg Oncol. 2005;12:459–66.CrossRefPubMed
21.
Adam R, Aloia T, Krissat J, Bralet MP, Paule B, Giacchetti S, et al. Is liver resection justified for patients with hepatic metastases from breast cancer? Ann Surg. 2006;244:897–907.CrossRefPubMed
22.
Furka A, Halasz L, Szentkereszty Z, Posan J, Andras C, Sapy P. Surgical treatment of liver metastases from breast cancer. Hepatogastroenterology. 2008;55:1416–8.PubMed
23.
Caralt M, Bilbao I, Cortes J, Escartin A, Lazaro JL, Dopazo C, et al. Hepatic resection for liver metastases as part of the “oncosurgical” treatment of metastatic breast cancer. Ann Surg Oncol. 2008;15:2804–10.CrossRefPubMed
24.
Lubrano J, Roman H, Tarrab S, Resch B, Marpeau L, Scotte M. Liver resection for breast cancer metastasis: does it improve survival? Surg Today. 2008;38:293–9.CrossRefPubMed
25.
Thelen A, Benckert C, Jonas S, Lopez-Hänninen E, Sehouli J, Neumann U, et al. Liver resection for metastases from breast cancer. J Surg Oncol. 2008;97:25–9.CrossRefPubMed
26.
Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer. 2006;94:982–99.CrossRefPubMed
27.
Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg. 1999;229:790–9.CrossRefPubMed
28.
Lanza LA, Natarajan G, Roth JA, Putnam JB Jr. Long-term survival after resection of pulmonary metastases from carcinoma of the breast. Ann Thorac Surg. 1992;54:244–7.CrossRefPubMed
29.
Friedel G, Linder A, Toomes H. The significance of prognostic factors for the resection of pulmonary metastases of breast cancer. Thorac Cardiovasc Surg. 1994;42:71–5.CrossRefPubMed
30.
McDonald ML, Deschamps C, Ilstrup DM, Allen MS, Trastek VF, Pairolero PC. Pulmonary resection for metastatic breast cancer. Ann Thorac Surg. 1994;58:1599–602.CrossRefPubMed
31.
Murabito M, Salat A, Mueller MR. [Complete resection of isolated lung metastasis from breast carcinoma results in a strong increase in survival]. Minerva Chir. 2000;55:121–7 (Italian).PubMed
32.
Friedel G, Pastorino U, Ginsberg RJ, Goldstraw P, Johnston M, Pass H, et al. Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases. Eur J Cardiothorac Surg. 2002;22:335–44.CrossRefPubMed
33.
Ludwig C, Stoelben E, Hasse J. Disease-free survival after resection of lung metastases in patients with breast cancer. Eur J Surg Oncol. 2003;29:532–5.CrossRefPubMed
34.
Planchard D, Soria JC, Michiels S, Grunenwald D, Validire P, Caliandro R, et al. Uncertain benefit from surgery in patients with lung metastases from breast carcinoma. Cancer. 2004;100:28–35.CrossRefPubMed
35.
Welter S, Jacobs J, Krbek T, Totsch M, Stamatis G. Pulmonary metastases of breast cancer: when is resection indicated? Eur J Cardiothorac Surg. 2008;34:1228–34.CrossRefPubMed
36.
Yoshimoto M, Tada K, Nishimura S, Makita M, Iwase T, Kasumi F, et al. Favourable long-term results after surgical removal of lung metastases of breast cancer. Breast Cancer Res Treat. 2008;110:485–91.CrossRefPubMed
37.
Chen F, Fujinaga T, Sato K, Sonobe M, Shoji T, Sakai H, et al. Clinical features of surgical resection for pulmonary metastasis from breast cancer. Eur J Surg Oncol. 2009;35:393–7.PubMed
38.
Swenerton KD, Legha SS, Smith T, Hortobagyi GN, Gehan EA, Yap HY, et al. Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res. 1979;39:1552–62.PubMed
39.
Patanaphan V, Salazar OM, Risco R. Breast cancer: metastatic patterns and their prognosis. South Med J. 1988;81:1109–12.PubMed
40.
Staren ED, Salerno C, Rongione A, Witt TR, Faber LP. Pulmonary resection for metastatic breast cancer. Arch Surg. 1992;127:1282–4.PubMed
41.
Pieper DR, Hess KR, Sawaya RE. Role of surgery in the treatment of brain metastases in patients with breast cancer. Ann Surg Oncol. 1997;4:481–90.CrossRefPubMed
42.
Wronski M, Arbit E, McCormick B. Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer. 1997;80:1746–54.CrossRefPubMed
43.
Fokstuen T, Wilking N, Rutqvist LE, Wolke J, Liedberg A, Signomklao T, et al. Radiation therapy in the management of brain metastases from breast cancer. Breast Cancer Res Treat. 2000;62:211–6.CrossRefPubMed
44.
Durr HR, Muller PE, Lenz T, Baur A, Jansson V, Refior HJ, et al. Surgical treatment of bone metastases in patients with breast cancer. Clin Orthop Relat Res. 2002;396:191–6.
45.
van Geel AN, Wouters MW, van der Pol C, Schmitz PI, Lans T. Chest wall resection for internal mammary lymph node metastases of breast cancer. Breast. 2009;18:94–9.CrossRefPubMed
46.
Incarbone M, Nava M, Lequaglie C, Ravasi G, Pastorino U. Sternal resection for primary or secondary tumors. J Thorac Cardiovasc Surg. 1997;114:93–9.CrossRefPubMed
47.
Ayhan A, Guvenal T, Salman MC, Ozyuncu O, Sakinci M, Basaran M. The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries. Gynecol Oncol. 2005;98:235–41.CrossRefPubMed
48.
McLemore EC, Pockaj BA, Reynolds C, Gray RJ, Hernandez JL, Grant CS, et al. Breast cancer: presentation and intervention in women with gastrointestinal metastasis and carcinomatosis. Ann Surg Oncol. 2005;12:886–94.CrossRefPubMed
49.
Castillo OA, Vitagliano G, Kerkebe M, Parma P, Pinto I, Diaz M. Laparoscopic adrenalectomy for suspected metastasis of adrenal glands: our experience. Urology. 2007;69:637–41.CrossRefPubMed
50.
Khan SA, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery. 2002;132:620–6.CrossRefPubMed
51.
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. Ann Surg Oncol. 2006;13:776–82.CrossRefPubMed
52.
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. J Clin Oncol. 2006;24:2743–9.CrossRefPubMed
53.
Fields RC, Jeffe DB, Trinkaus K, Zhang Q, Arthur C, Aft R, et al. 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 metastasis. Ann Surg Oncol. 2007;14:3345–51.CrossRefPubMed
54.
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. Ann Surg Oncol. 2007;14:2187–94.CrossRefPubMed
55.
Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM. Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg. 2008;247:732–8.CrossRefPubMed
56.
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. Eur J Surg Oncol. 2009;35:1146–51.PubMed
57.
Cady B, Nathan NR, Michaelson JS, Golshan M, Smith BL. Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol. 2008;15:3384–95.CrossRefPubMed
58.
Danna EA, Sinha P, Gilbert M, Clements VK, Pulaski BA, Ostrand-Rosenberg S. Surgical removal of primary tumor reverses tumor-induced immunosuppression despite the presence of metastatic disease. Cancer Res. 2004;64:2205–11.CrossRefPubMed
59.
Fields RC, Margenthaler JA. Surgical resection of the primary tumor in stage IV breast cancer patients: is a randomized, controlled trial imperative or too costly? J Surg Oncol. 2009;99:85–6.CrossRefPubMed
Metadata
Title
Metastasectomy and Surgical Resection of the Primary Tumor in Patients With Stage IV Breast Cancer
Time for a Second Look?
Authors
Barbara A. Pockaj, MD
Nabil Wasif, MD
Amylou C. Dueck, PhD
Dennis A. Wigle, MD
Judy C. Boughey, MD
Amy C. Degnim, MD
Richard J. Gray, MD
Sarah A. McLaughlin, MD
Donald W. Northfelt, MD
Robert P. Sticca, MD
James W. Jakub, MD
Edith A. Perez, MD
Publication date
01-09-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 9/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1016-1

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