title: Surgery of the primary tumor in de novo metastatic breast cancer: To do or not to do?
abstract: Approximately five percent of all breast cancer patients in developed countries present with distant metastases at initial diagnosis. Due to its incurability, metastatic breast cancer is generally treated with systemic therapies to achieve disease control and reduce tumor-related symptoms. Primary treatments for metastatic breast cancer are chemotherapy, endocrine- and biologic therapy, whereas surgery with or without radiotherapy is usually performed to treat impending wound issues. Since 2002, several retrospective non-randomized clinical studies have shown that extirpation of the primary tumor correlates with a significantly improved survival in patients with primary metastatic breast cancer. Others have argued that this survival benefit associated with surgery may be due to selection biases. Therefore, in the absence of published results from randomized controlled trials carried out in India and Turkey and completion of a trial in the United States, there is no clear conclusion on whether surgical excision of the primary breast cancer translates into a survival benefit for patients with de novo metastatic disease. Furthermore, timing and type of surgical procedure, as well as selection of patients who could benefit the most from this approach, represent additional points of uncertainty. Despite the epidemiological burden of this condition, there are no guidelines on how to manage breast cancer patients presenting with de novo metastatic breast cancer; and decisions are often left to provider and patient preferences. Here, we present a critical overview of the literature focusing on the rationale and potential role of primary tumour excision in patients with de novo metastatic breast cancer.
authors.affiliation: Division of Experimental Cancer Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Criscitiello
authors.affiliation: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Breast Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Division of Experimental Cancer Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Curigliano
authors.affiliation: Medical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione Pascale, Napoli, Italy.
authors.forename: M
authors.initials: M
authors.lastname: De Laurentiis
authors.affiliation: Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Arpino
authors.affiliation: General Surgery, Department of Advanced Biomedical Science, University Federico II, Napoli, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Carlomagno
authors.affiliation: Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Placido
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Golshan
authors.affiliation: General Surgery, Department of Advanced Biomedical Science, University Federico II, Napoli, Italy. Electronic address: michele.santangelo@unina.it.
authors.forename: M
authors.initials: M
authors.lastname: Santangelo
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Primary metastatic breast cancer; Surgery; Survival