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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.

SEM RESUMO

A insuficiência de ALDH2 gera acetaldeído em excesso, acarretando os sinais e sintomas do flushing facial também conhecido como Asian Glow ou Síndrome do Rubor Facial. Vem acompanhado de náuseas e cefaleia, sendo considerado um possível fator protetor ao alcoolismo devido ao quadro clínico. A presente revisão tem como objetivo avaliar a relação do Asian Glow com o Câncer de Esôfago e seus fatores influenciadores na incidência da polução asiática. Uma revisão sistemática das literaturas com acesso eletrônico livre nas bases de dados PubMed, Ministério da Saúde e Biblioteca Virtual em Saúde (BVS), com um número total de 9 artigos selecionados no idioma inglês, filtrando exclusivamente os artigos com correlação câncer-asian glow. Os critérios para inclusão foram publicações de artigos científicos no período compreendido entre 2009 e 2019. Conclui-se que o aumento do consumo de álcool em todo o mundo tem relação direta com a maior incidência de cânceres no mundo, principalmente nos países do Leste Asiático onde a porcentagem de indivíduos com deficiência de ALDH2 é alto. Analisando todos os quatro pontos principais: o polimorfismo dos genes codificadores da ALDH2, o asian glow, a tolerância à manifestação do rubor e o Câncer de Esôfago (CE) podemos chegar a um resultado final. O CE não tem relação com o Asian Glow, mas com a deficiência da ALDH2 que causa em alguns pacientes essa síndrome.

Objective: Resection of the primary tumor in metastatic breast cancer is controversial in literature. Some evidence have suggested that women who undergo resection of the primary metastatic breast cancer achieved improved survival outcomes. The objective of this study is to evaluate the impact of primary tumor resection (PTR) in patients with metastatic breast cancer. Methodology: Literature review. We performed our search in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Wiley Online Library, Scopus, and PubMed Central (PMC). Eight studies from 2016-2019, including randomized controlled trials, meta-analysis, and systematic reviews were selected. Results: Although there are some polemic opinions about the surgical treatment, the latest studies that we have analyzed emphasized that PTR is associated with better prognosis in women with metastatic breast cancer. In most studies, it was reported in literature that progression-free survival (PFS) is better on those who underwent surgery. In addition, primary tumor resection has been reported to be associated with longer progression-free survival at a distance (Hazard Ratios 0.42). Improved survival was even associated with surgery regardless of tumor size. An expert group of oncologists from India came to a consensus that surgery for primary tumor should be done in patients with oligometastatic breast cancer. A similar conclusion was reached by a research group in Mexico, who suggest that PTR has a positive impact on women PFS and borderline overall survival, particularly benefiting those with oligomethasic disease. Primary tumor resection was also associated with a longer median overall survival (OS). On a study conducted in USA, which included 29,916 patients with metastatic breast cancer, 15,129 (51%) underwent primary tumor resection, and 14,787 (49%) patients did not undergo surgery. OS achieved was 34 vs 18 months, in favor of surgical patients. A retrospective cohort study in USA registered survival of at least 10 years seen in 9.6% (n=353) and 2.9% (n=107) of those who did and did not receive surgery, respectively. Additionally, those undergoing surgery had longer median survival than those who did not (28 months vs 19 months). In women with de novo stage IV breast cancer, current studies show that surgical resection of the primary tumor occurs in almost half of those alive 1 year after diagnosis. However, we acknowledge that there are considerable discussions about the selection of patients, since most studies are likely to choose those with good status performance. Conclusion: The primary role of local treatment to the breast in metastatic breast cancer is palliation. Patients with metastatic disease should be evaluated for possible local management of the primary if it may control local complications from the cancer (e.g. bleeding, infection, or wound management). Based in the analysis, primary tumor resection in metastatic breast cancer is associated with higher survival rates, when compared to not surgical gro...