The role of surgery in metastatic breast cancer

Ruiterkamp, J.; Ernst, Miranda F.

doi:10.1016/s0959-8049(11)70142-3

Cited by 75 publications

(51 citation statements)

References 119 publications

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“…allowing for long term disease control in a good proportion of cases. [3][4][5] These findings confirm distinct biology of oligometastases based on the restricted tumor metastatic capacity. 2 In the last decade stereotactic body radiotherapy (SBRT) has become a new local treatment option for the limited volume primary cancer (non small cell lung cancer, hepatocellular carcinoma, renal cancer, prostate cancer etc.)…”

Section: Introductionsupporting

confidence: 62%

Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?

Jereczek‐Fossa

Ronchi

Orecchia

2015

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tObjectives: To review the available data about stereotactic body-radiotherapy (SBRT) for oligometastatic lymph node cancer recurrence. Methods:The inclusion criteria for this study were as follows: Medline search for the (1) English language (2) full paper (abstracts were excluded) on (3) adult oligometastatic solid cancer recurrence limited to lymph node that underwent SBRT (4) outcome data available and (5) published up to the 30th April 2014.Results: 38 papers fulfilling the inclusion criteria have been found: 7 review articles and 31 patient series (20 and 11 retrospective and prospective studies, respectively) including between 1 and 69 patients (636 lymph nodes). Twelve articles reported only lymph node SBRT while in 19 -all types of SBRT including lymph node SBRT were presented. Two-year local control, 4-year progression free survival and overall survival was of up to 100%, 30% and 50%, respectively. The progression was mainly out-field (10-30% of patients had a recurrence in another lymph node/nodes). The toxicity was low with mainly mild acute events and single grade 3-4 late events. When compared to SBRT for any oligometastatic cancer, SBRT for lymph node recurrence carried better prognosis and showed lower toxicity.Conclusions: SBRT is a feasible approach for oligometastatic lymph node recurrence, offering excellent in-field tumor control with low toxicity profile. The potential abscopal effect has been hypothesized as a basis of these findings. Future studies are warranted to identify the patients that benefit most from this treatment. The optimal combination with systemic treatment should also be defined.

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Section: Introductionsupporting

confidence: 62%

Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?

Jereczek‐Fossa

Ronchi

Orecchia

2015

Reports of Practical Oncology & Radiotherapy

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“…Despite the prevailing, clear recommendation against nonpalliative primary tumor surgery in metastatic breast cancer, removing the primary tumor has been associated with decreased overall mortality in several retrospective studies, [5][6][7][8][9][10][11][12][13][14][15][16][17][18] with a hazard ratio for mortality of 0.65 (0.59-0.72) 19 and 0.69 (0.63-0.77) 20 according to 2 recent meta-analyses. These results were found after multivariable statistical adjustment for confounding factors such as patient age, oligo-/multimetastatic status, hormone and HER2 receptor status, nodal status, and adjuvant local and systemic treatment among others.…”

mentioning

confidence: 99%

Improved Survival After Primary Tumor Surgery in Metastatic Breast Cancer

et al. 2016

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The present study-the first population-based analysis using propensity score methods-provides evidence of a favorable impact of primary tumor surgery on mortality in metastatic breast cancer patients. Most importantly, the benefit of primary tumor surgery increased over time from 1998 to 2009. Although the final results of ongoing randomized studies are awaited, currently available evidence should be discussed with metastatic breast cancer patients.

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“…Often multiple organ systems are affected, with only 5% of liver metastases presenting as isolated lesions. 3 resection technically unfeasible, even in those patients with disease isolated to the liver. These factors significantly reduce the number of patients who are potential candidates for surgical therapy.…”

Section: Discussionmentioning

confidence: 99%

Surgical Resection of a Liver Metastasis from Breast Cancer

Selvakumar

Dube

Matey

2015

annals

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We report a case of a solitary liver metastasis from breast cancer in a 65-year-old woman. The patient underwent a mastectomy and axillary lymph node clearance for right breast cancer in 1990. A solitary metastasis was found in the left lobe of the liver by ultrasonography, 20 years after the initial mastectomy. A left lateral segmentectomy was performed in January 2011 and adjuvant hormonal therapy was also initiated. At present, she remains disease free.This case demonstrates the implementation of liver resection to provide an effective treatment for metachronous metastatic breast cancer. We encourage surgeons to offer suitable patients this surgical treatment option, which is shown to provide a survival benefit. KEYWORDSBreast cancer -Liver metastases -Liver resection Breast cancer is the most common cancer in females. A fifth of breast cancer patients have metastatic disease and in more than half of these patients, the liver is involved. 1Metastatic disease is associated with a shorter median survival time and, currently, the mainstay of treatment is medical, in the form of hormonal treatment and chemotherapy. However, recent studies worldwide have shown that in highly selected patients, surgical resection of liver metastases can have a significant survival benefit. Case HistoryA 65-year-old woman was found to have mildly deranged liver function tests (alanine transaminase 145iu/l, gammaglutamyltransferase 69iu/l) on a routine health check-up. She had a history of right-sided breast cancer, which had been treated with a mastectomy, axillary lymph node clearance and adjuvant hormonal therapy 20 years earlier. Following this, she had multiple reconstructive surgeries to both breasts, resulting in a deep inferior epigastric tissue reconstruction of the right breast and an implant reconstruction of the left breast.There was no history of weight loss, abdominal pain or distension, loss of appetite or any sinister symptoms. Physical examination was unremarkable with no discernible anaemia, jaundice or lymphadenopathy.Ultrasonography of the abdomen revealed a solitary 1.5cm heterogeneous lesion in the left lobe of the liver with no other demonstrable pathology. Further imaging with computed tomography of thorax, abdomen and pelvis (Fig 1) confirmed the lesion was localised to segment 2 of the liver, and there was no extrahepatic disease.Initially, careful surveillance of the lesion was undertaken with repeat ultrasonography (Fig 2) and magnetic resonance imaging (MRI) after two months. Repeat imaging demonstrated enlargement of the lesion to 1.8cm.At this stage, the patient was referred to a regional hepatobiliary surgical unit. After satisfactory anaesthetic assessment, she underwent a left lateral segmentectomy to resect this solitary liver lesion. Histology confirmed that this was a breast metastasis and that the resection was successful (R0), achieving disease free clearance margins. Adjuvant treatment was with an aromatase inhibitor (letrozole) owing to positive oestrogen receptor status. At the time o...

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The role of surgery in metastatic breast cancer

Cited by 75 publications

References 119 publications

Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?

Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?

Improved Survival After Primary Tumor Surgery in Metastatic Breast Cancer

Surgical Resection of a Liver Metastasis from Breast Cancer

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