Resection of the primary tumor improves survival in metastatic breast cancer by reducing overall tumor burden

Introduction: In advanced breast cancer, local treatment is considered palliative. However, although there are some polemic opinions about the surgical treatment, some of the latest studies have emphasized that in advanced cases primary tumor resection (PTR) is related to better outcomes. This review aims to evaluate how resection of the original tumor impacts women with metastatic breast cancer, considering the most recent studies about this subject. Methods: The search was performed in MEDLINE, Scopus, PMC, Current Contents and Wiley Online Library databases; 23 articles - from 2016 to 2019 - were selected and 11 were included in this review. As inclusion criteria were considered: studies presenting outcomes about resection of the primary tumor, comparison between chemotherapy/ hormone therapy/ targeted cancer therapies and surgical intervention, studies published from 2016 to 2019 and available in English, Spanish or Portuguese. We excluded those which did not approach PTR, did not present outcomes of interest (progression-free survival comparison between PTR and systemic therapy) or only discussed systemic therapy, as well as those published before 2016. Results: It was reported in 6 studies that progression-free survival is better on those who underwent surgery. PTR was also related to longer median overall survival in women submitted to surgery, up to 16 months higher when compared to the ones who were not. Enhanced survival even pertained to surgical groups regardless of tumor size. Conclusion: Based in the analysis, PTR in metastatic breast cancer can be related to higher overall survival.

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Primary Tumor Levels of Tissue Inhibitor of Metalloproteinases-1 Are Predictive of Resistance to Chemotherapy in Patients with Metastatic Breast Cancer

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-06-0950 ◽

2006 ◽

Vol 12 (23) ◽

pp. 7054-7058 ◽

Cited By ~ 51

Author(s):

Anne-Sofie Schrohl ◽

Marion E. Meijer-van Gelder ◽

Mads N. Holten-Andersen ◽

Ib Jarle Christensen ◽

Maxime P. Look ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Primary Tumor ◽

Metastatic Breast ◽

Tissue Inhibitor Of Metalloproteinases ◽

Tissue Inhibitor ◽

Resistance To Chemotherapy

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Surgical Treatment of the Primary Tumor in Patients with Metastatic Breast Cancer (Stage IV Disease)

Breast Cancer ◽

10.1007/978-3-319-48848-6_29 ◽

2017 ◽

pp. 385-398

Author(s):

Mattia Intra

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Surgical Treatment ◽

Primary Tumor ◽

Metastatic Breast ◽

Stage Iv ◽

Cancer Stage ◽

Stage Iv Disease

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Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (EA2108)

Journal of Clinical Oncology ◽

10.1200/jco.21.02006 ◽

2022 ◽

Author(s):

Seema A. Khan ◽

Fengmin Zhao ◽

Lori J. Goldstein ◽

David Cella ◽

Mark Basik ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Metastatic Breast Cancer ◽

Systemic Therapy ◽

Primary Tumor ◽

Metastatic Breast ◽

Primary Site ◽

Locoregional Control ◽

Locoregional Therapy

PURPOSE Distant metastases are present in 6% or more of patients with newly diagnosed breast cancer. In this context, locoregional therapy for the intact primary tumor has been hypothesized to improve overall survival (OS), but clinical trials have reported conflicting results. METHODS Women presenting with metastatic breast cancer and an intact primary tumor received systemic therapy for 4-8 months; if no disease progression occurred, they were randomly assigned to locoregional therapy for the primary site (surgery and radiotherapy per standards for nonmetastatic disease) or continuing sysmetic therapy. The primary end point was OS; locoregional control and quality of life were secondary end points. The trial design provided 85% power to detect a 19.3% absolute difference in the 3-year OS rate in randomly assigned patients. The stratified log-rank test and Cox proportional hazards model were used to compare OS between arms. Cumulative incidence of locoregional progression was compared using Gray's test. Quality-of-life assessment used standard instruments. RESULTS Of 390 participants enrolled, 256 were randomly assigned: 131 to continued systemic therapy and 125 to early locoregional therapy. The 3-year OS was 67.9% without and 68.4% with early locoregional therapy (hazard ratio = 1.11; 90% CI, 0.82 to 1.52; P = .57). The median OS was 53.1 months (95% CI, 47.9 to not estimable) in the systemic therapy arm and 54.9 months (95% CI, 46.7 to not estimable) in the locoregional therapy arm. Locoregional progression was less frequent in those randomly assigned to locoregional therapy (3-year rate: 16.3% v 39.8%; P < .001). Quality-of-life measures were largely similar between arms. CONCLUSION Early locoregional therapy for the primary site did not improve survival in patients presenting with metastatic breast cancer. Although it was associated with improved locoregional control, this had no overall impact on quality of life.

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Is Surgery of the Primary Tumor Convenient in Metastatic Breast Cancer?

Annals of Oncology ◽

10.1016/s0923-7534(20)32932-x ◽

2012 ◽

Vol 23 ◽

pp. ix131-ix132

Author(s):

F. Petrelli ◽

M. Cabiddu ◽

K.F. Borgonovo ◽

M. Ghilardi ◽

F. Maspero ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Primary Tumor ◽

Metastatic Breast

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Survival impact of primary tumor resection in de novo metastatic breast cancer patients (GEICAM/El Alamo Registry)

Scientific Reports ◽

10.1038/s41598-019-55765-9 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Sara Lopez-Tarruella ◽

M. J. Escudero ◽

Marina Pollan ◽

Miguel Martín ◽

Carlos Jara ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Cancer Patients ◽

Primary Tumor ◽

Cox Regression ◽

De Novo ◽

Histological Grade ◽

Tumor Resection ◽

Metastatic Breast ◽

Breast Cancer Patients

AbstractThe debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. We explored this approach’s outcomes in patients included in a retrospective registry, named El Álamo, of breast cancer patients diagnosed in Spain (1990–2001). In this analysis we only included de novo MBC patients, 1415 of whom met the study’s criteria. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Median age was 63.1 years, 49.2% of patients had single-organ metastasis (skin/soft tissue [16.3%], bone [33.8%], or viscera [48.3%]). PT surgery (S) was performed in 44.5% of the cases. S-group patients were younger, had smaller tumors, higher prevalence of bone and oligometastatic disease, and lower prevalence of visceral involvement. With a median follow-up of 23.3 months, overall survival (OS) was 39.6 versus 22.4 months (HR = 0.59, p < 0.0001) in the S- and non-S groups, respectively. The S-group OS benefit remained statistically and clinically significant regardless of metastatic location, histological type, histological grade, hormone receptor status and tumor size. PT surgery (versus no surgery) was associated with an OS benefit suggesting that loco-regional PT control may be considered in selected MBC patients. Data from randomized controlled trials are of utmost importance to confirm these results.

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