title: Management of liver dominant metastatic breast cancer: surgery, chemotherapy, or hepatic arterial therapy - benefits and limitations.
abstract: OBJECTIVE
  Systemic hormonal and cytotoxic chemotherapy still remains the optimal treatment for metastatic breast cancer with the role of surgery being strictly limited for palliation of metastatic complications or locoregional relapse. However there has been a greater awareness of liver dominant and liver only metastatic disease that remains more refractory to systemic chemotherapy alone. A systematic review was undertaken to define its safety, efficacy and to identify prognostic factors associated with liver only or liver dominant metastatic breast cancer.
  
  
  METHODS
  Electronic search of the MEDLINE, PubMed and Scopus databases (January 2000-January 2012) to identify studies reporting outcomes for liver dominant breast cancer metastasis. Two reviewers independently appraised each study using a predetermined protocol. Safety and clinical efficacy was synthesized through a narrative review with full tabulation of results of all included studies.
  
  
  RESULTS
  A total of 61 studies were identified that reported liver dominant metastatic breast cancer and comprised a total of 8260 patients. Chemotherapy alone was reported in 27 studies involving 4958 patients with a median overall survival of 17.9 months (range 6 to 29.2). Surgical resection of liver metastasis was reported in 24 studies involving 2552 patients with a median overall survival of 38.1 months (range 10.9 to 57). Hepatic arterial therapy was reported in six studies involving 373 patients with a median overall survival of 27.9 months (range 18.5 to 47).
  
  
  CONCLUSIONS
  Liver dominant or liver only metastatic breast cancer is a common presentation and clinical problem in a subset of patients. Consideration of hepatic resection, ablation or hepatic arterial therapy should be considered, but are still rarely performed. Continued review and identification of liver only-liver dominant is needed to ensure this subset of patients with metastatic breast cancer can achieve optimal improvement in quality of life time.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Rodes Brown
authors.forename: R C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome