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

• Published in: Breast cancer research and treatment Vol. 119; no. 3; pp. 537 - 545
• Main Authors: Ly, Bevan H, Nguyen, Nam P, Vinh-Hung, Vincent, Rapiti, Elisabetta, Vlastos, Georges
• Format: Journal Article
• Language: English
• Published: Boston Boston : Springer US 01-02-2010; Springer US; Springer; Springer Nature B.V
• Subjects: Analysis; Biological and medical sciences; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Cancer; Cancer patients; Cancer research; Cancer therapies; Chemotherapy; Combined Modality Therapy; Disease-Free Survival; Drug therapy; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Mastectomy; Medical sciences; Medical treatment; Medicine; Medicine & Public Health; Metastasis; Neoplasm Staging; Nuclear radiation; Oncology; Patient outcomes; Radiotherapy; Randomized Controlled Trials as Topic; Review; Risk Factors; Systematic review; Tumors; Loco-regional treatment; Radiotherapy; Survival; Surgery; Stage IV breast cancer; Human; Regional treatment; Breast disease; Patient; Breast cancer; Malignant tumor; Metastasis; Mammary gland diseases; Advanced stage; Cancer
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-009-0610-z

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.