Liver resection and local ablation of breast cancer liver metastases – A systematic review

Abstract

Aim : To analyze surgical treatment of breast cancer liver metastases (BCLM) regarding selection criteria, outcome and prognostic parameters.Methods : We searched Embase and Medline for all studies published 1999-2010.Results : Resection was associated with a median survival (MOS) of 20-67 months and 5-year survival of 21-61%. Local ablation also had a favourable outcome; MOS was 30-60 months and and 5-year survival 27-41%. Regarding selection, no specific limits regarding the number and size of BCLM can be given. Features of the primary breast cancer (BC) was not significant for the prognosis. Microscopically radical (R0) resection is a positive prognostic factor, while the effects of disease interval, hormone receptor status and response to preoperative chemotherapy were divergent. The presence of EHD had a negative effect on survival in some studies, but failed to have so in other studies.Conclusions: Surgical therapy may benefit a subset of patients with BCLM. Resection may be indicated, if an RO-resection can be done with a low risk of mortality. Liver resection in the presence of extrahepatic disease remains controversial, while patients with BCLM and bone metastases could possibly be managed differently than other EHD.

Surgical Resection of a Liver Metastasis from Breast Cancer

“…However, radiofrequency ablation should not be used for large metastatic lesions as the area of induced necrosis is typically <3cm. 5 …”

Prognostic Factors In Breast Cancer Patients With Hepatic Metastases: Impact Of Molecular Subtype And Local Hepatic Treatment

“…It has been reported that nearly 30% of breast cancer patients will develop liver metastases along the duration of their disease. 1-2 Liver metastases usually develop in the terminal stage of breast Hepatic with brain 13 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) International Journal of Hematology and Oncology cancer, and are often accompanied by extrahepatic metastases. Isolated liver metastases are very rare (4%-5%).…”

“…Microscopically complete (R0) resection of metastases were found to be a favorable prognostic factor in multiple studies reported in the literature [19][20] ; local ablation studies produced similar results with five year survival rates reaching up to 40%. 21 Performed in small prospective studies, it has been shown that RFA is also effective. In our study, we showed that local treatment (metastasectomy, RFA, radio embolization and TACE) provided statistically better survival according to both univariate and multivariate analysis (36 vs 18 months).…”

Oligometastasis and oligo-recurrence: more than a mirage

“…A systematic review of >1000 patients with breast cancer and liver metastasis showed 2-, 3- and 5-year survival rates of 58-86%, 35-79% and 21-61%, respectively [13]. Liver metastasectomy of neuroendocrine tumors (NET) has also been shown to benefit most patients (95%) and prolong survival [14].…”

“…A systematic review by Bergenfeldt et al analyzed patients with breast cancer and liver oligometastases who had undergone metastasectomy and patients who had received local ablation therapy such as SBRT, they showed that surgical resection led to 5-year OS rates of 25-42%, that local ablation therapy had similar survival results, and R0 resection was a strong prognostic factor for survival [13]. …”