title: Is primary surgery for locally advanced/metastatic breast cancer a better choice than chemotherapic treatment?
abstract: BACKGROUND
  A part of the literature supports the undoubtful advantage of neoadjuvant chemotherapy on the overall survival and for the possibility of surgical conservative treatment in locally advanced tumours after downstaging. Other authors report that primitive tumour's surgical removal at first, improves survival in cases with locally advanced /metastatic disease. The advantages were improvement of patient's health status, removal of a reservoir of neoplastic cell neoangiogenic cytokines and growth factors,and cytoreduction.
  
  
  METHODS
  Aim of this study is to evaluate the effectiveness on the survival of a primary surgical treatment of the locally advanced tumours comparing two homogeneous groups. In the first group (GROUP 1) 40 patients were enrolled with stage III A, III B,IV tumours and were treated with primary surgery. The second group (GROUP 2) was made up of 40 patients with similar stage treated with neoadjuvant chemotherapy. The surgical treatment had the intention to remove the entire primary tumour.
  
  
  RESULTS
  After a median follow up of 48,2 months,22,5 % of GROUP 1 died and 30 % of GROUP 2. The average survival of patients in GROUP 1 was 27,1 months while in GROUP 2 there was an average survival of 16,8 months.
  
  
  CONCLUSIONS
  In conclusion surgical treatment plays a key role in the treatment of advanced/metastatic disease and is an independent factor associated with survival.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Libero
authors.forename: Antonio
authors.initials: A
authors.lastname: Varricchio
authors.forename: Carlo
authors.initials: C
authors.lastname: Iannace
authors.forename: Domenico
authors.initials: D
authors.lastname: Lo Conte
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Candela
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colantuoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Testa
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome