Metastasectomy and surgical resection of the primary tumor in patients with stage IV breast cancer: time for a second look?
Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.
Department of Surgery, Mayo Clinic, Scottsdale, AZ, USA. pockaj.barbara@mayo.edu
Barbara A
BA
Pockaj
Nabil
N
Wasif
Amylou C
AC
Dueck
Dennis A
DA
Wigle
Judy C
JC
Boughey
Amy C
AC
Degnim
Richard J
RJ
Gray
Sarah A
SA
McLaughlin
Donald W
DW
Northfelt
Robert P
RP
Sticca
James W
JW
Jakub
Edith A
EA
Perez
D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D024162:Second-Look Surgery