Distant metastatic breast cancer as an incurable disease: a tenet with a need for revision.
OBJECTIVE
Published reports provide level-III evidence in support of the hypothesis that distant metastatic breast cancer (MBC) might be curable in up to 3% of cases through a multidisciplinary approach including combination chemotherapy regimens in selected patients, usually young, and with limited metastases. Our study evaluates the rate and characteristics of long-term survivors based on a nonselective study cohort.


METHODS
We analyzed the data from 149 patients in whom distant MBC was diagnosed from 1990 to 1999.


RESULTS
Five patients (3.4%) were long-term survivors (9-14 years after initial diagnosis of MBC) without any clinical evidence of disease. They had a 2-peaked distribution of age: 3 were 41-57 years old at the diagnosis of MBC and 2 were much older (76, 79 years). Median survival time after diagnosis of MBC was 152 (range, 109-172) months. Three patients had isolated metastatic lesions, although 1 patient had multiple organ metastases and another extensive bone metastases. In 4 of 5 cases, long-term survival was achieved without the administration of chemotherapy.


CONCLUSIONS
Long-term survivors in MBC comprise a relatively heterogeneous group, and the factors which lead to the quite rare situation of long-term survival can hardly be evaluated systematically. Aggressive chemotherapy regimens appear not to be a key factor for survival. Furthermore, in a nonselective study cohort, some patients clearly are not only alive but also disease-free more than 12 years after initial relapse. This fraction may be small, but the chance for survival, and even for cure, truly exists.
Güth
Uwe
U
Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, Basel CH-4031, Switzerland. ugueth@uhbs.ch
Huang
Dorothy Jane
DJ
Dirnhofer
Stephan
S
Rochlitz
Christoph
C
Wight
Edward
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D017741:Survivors