title: Treatment of primary breast tumors in de novo metastatic breast cancer.
abstract: BACKGROUND
  De novo metastatic breast cancer accounts for about 3% to 6% of the more than 200,000 new breast cancer cases annually in the United States. The treatment of the primary breast tumor in these cases is a widely debated topic. Some feel that surgical resection of the breast tumor is appropriate for selected patients, whereas others recommend surgical resection only to treat or prevent uncontrolled chest wall disease.
  
  
  METHODS
  We review the published data on treatment of the primary tumor in de novo metastatic breast cancer, including retrospective population-based and single-institution studies. We then report on the first 2 randomized controlled trials (RCTs) that evaluated the effect on survival of surgical resection of the primary breast tumor.
  
  
  RESULTS
  Results of the published retrospective analyses are varied, but in general they associate resection with improved outcome. Early results from the first RCTs point to no survival advantage with resection of the primary tumor in this population, but important limitations of the RCTs are noted.
  
  
  CONCLUSIONS
  The early data from RCTs do not show survival benefit from surgical resection of the primary tumor in de novo metastatic breast cancer, but these studies have some important limitations and also suggest that certain subsets may benefit. The question therefore remains unanswered, which should provide greater impetus for the completion of ongoing RCTs.
authors: PinnacleHealth, Harrisburg, PA.
authors: Theresa
authors: T
authors: Lee
authors: Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
authors: Claudine
authors: C
authors: Isaacs
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008408:Mastectomy; D009362:Neoplasm Metastasis; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D018426:SEER Program
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human