title: Loco-regional treatment in metastatic breast cancer patients: is there a survival benefit?
abstract: A number of studies have recently demonstrated a survival benefit in stage IV breast cancer patients following surgical resection of the primary tumor. Here, we investigate the relationship between loco-regional treatment and survival in patients with metastatic breast cancer and evaluate the impact of different loco-regional treatments. We conducted a systematic review of the literature using PubMed to analyze studies with the following criteria: Type of loco-regional treatment (surgery alone or combined with radiation, radiotherapy), overall survival, progression-free survival, selection factors for local treatment, and complication rates. Thirteen studies evaluated the effect of loco-regional treatment on overall survival with overall median survival increasing from a range of 12.6-28.3 months among patients without surgery to a range of 25-42 months among patients with surgery. In addition, six studies reported a 3-year survival benefit of 28-95% and 17-79% in women with and without locoregional therapy respectively. Two studies did not find any improvement in overall survival. One study found an improvement in 5-year breast cancer-specific survival of 27% with negative surgical margins versus 12% with no surgery. Three studies reported an advantage in progression-free survival in the treatment group compared with the non-treatment group. Loco-regional treatment for breast cancer patients with distant metastases at diagnosis is an important issue because of possible improvement of survival or disease-free survival. The possibility of surgery and/or radiotherapy following induction chemotherapy should be weighed and left to individual practice. Participation in randomized controlled trials should be encouraged.
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St., Honolulu, HI 96813, USA. bevan@hawaii.edu
authors.forename: Bevan H
authors.initials: BH
authors.lastname: Ly
authors.forename: Nam P
authors.initials: NP
authors.lastname: Nguyen
authors.forename: Vincent
authors.initials: V
authors.lastname: Vinh-Hung
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Rapiti
authors.forename: Georges
authors.initials: G
authors.lastname: Vlastos
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008408:Mastectomy; D009367:Neoplasm Staging; D011878:Radiotherapy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors