Hepatectomy, RFA, and Other Liver Directed Therapies for Treatment of Breast Cancer Liver Metastasis: A Systematic Review

Abstract

BackgroundThe liver is the second most common site of breast cancer metastasis. Liver directed therapies including hepatic resection, radiofrequency ablation (RFA), transarterial chemo- and radioembolization (TACE/TARE), and hepatic arterial infusion (HAI) have been scarcely researched for breast cancer liver metastasis (BCLM). The purpose of this review is to present the known body of literature on these therapies for BCLM.MethodsA systematic review was performed with pre-specified search terms using PubMed, MEDLINE, EMBASE, and Cochrane Review resulting in 9,957 results. After review of abstracts and application of exclusion criteria, 51 studies were included in this review.ResultsHepatic resection afforded the longest median overall survival (mOS) and 5-year survival (45 mo, 41%) across 23 studies. RFA was presented in six studies with pooled mOS and 5-year survival of 38 mo and 11–33%. Disease burden and tumor size was lower amongst hepatic resection and RFA patients. TACE was presented in eight studies with pooled mOS and 1-year survival of 19.6 mo and 32–88.8%. TARE was presented in 10 studies with pooled mOS and 1-year survival of 11.5 mo and 34.5–86%. TACE and TARE populations were selected for chemo-resistant, unresectable disease. Hepatic arterial infusion was presented in five studies with pooled mOS of 11.3 months.ConclusionAlthough further studies are necessary to delineate appropriate usage of liver directed therapies in BCLM, small studies suggest hepatic resection and RFA, in well selected patients, can result in prolonged survival. Longitudinal studies with larger cohorts are warranted to further investigate the effectiveness of each modality.

A systematic review and meta-analysis on the efficacy and safety of transcatheter arterial chemoembolization combined with radiofrequency ablation in the treatment of primary liver cancer

“…Primary liver cancer, referred to as liver cancer, is an epithelial malignant tumor originating from the liver ( 1 ). Primary liver cancer is the fifth most common cancer worldwide, accounting for 5.6% of all cancers ( 2 - 4 ).…”

Prognostic Factors in Patients with Breast Cancer Liver Metastases Undergoing Liver Resection: Systematic Review and Meta-Analysis

“…However, surgery is not routinely performed for metastatic liver tumors in patients with breast cancer. For patients with disease limited to the liver or stable extrahepatic oligometastatic disease undergoing systemic treatment, the surgical approach has been described in several retrospective series with 5 year OS ranging widely between 9% and 78% [ 6 ]. However, there is high variability in the eligibility criteria for resection, and the weakness of these criteria reflects the lack of identified prognostic, predictive factors, as previously reviewed [ 14 , 15 ].…”

“…Several retrospective case series have been published evaluating patients’ survival following resection for BCLM, reporting 5 year survival rates ranging from 9% to over 78% [ 4 , 5 , 6 ]. These uneven results are likely due to the highly variable inclusion criteria for hepatic resection among different series, such as the presence or absence of extrahepatic disease.…”

Does hepatectomy improve outcomes of breast cancer with liver metastasis? A nationwide analysis of real-world data in Taiwan

“…A comparison of patients who underwent RFA revealed that hepatic resection was associated with better 5-year OS (odds ratio [OR] = 0.38; 95% CI, 0.32–0.46; p <0.001) and 5-year disease-free survival (OR = 0.51; 95% CI, 0.40–0.66; p <0.001) [ 54 ]. Another meta-analysis of 23 studies revealed that hepatic resection resulted in longer median overall survival (mOS) and 5-year survival (45 months, 41%) than RFA (38 months and 11–33%) or TACE (mOS, 19.6 months; 1-year survival: 32–88.8%, n = 8 studies) [ 55 ]. In Taiwan, the most indication for RFA was hepatocellular carcinoma.…”