Loco-regional treatment in metastatic breast cancer patients: Is there a survival benefit?
Tóm tắt
A number of studies have recently demonstrated a survival benefit in stage IV breast cancer patients following surgical resection of the primary tumor. Here, we investigate the relationship between loco-regional treatment and survival in patients with metastatic breast cancer and evaluate the impact of different loco-regional treatments. We conducted a systematic review of the literature using PubMed to analyze studies with the following criteria: Type of loco-regional treatment (surgery alone or combined with radiation, radiotherapy), overall survival, progression-free survival, selection factors for local treatment, and complication rates. Thirteen studies evaluated the effect of loco-regional treatment on overall survival with overall median survival increasing from a range of 12.6–28.3 months among patients without surgery to a range of 25–42 months among patients with surgery. In addition, six studies reported a 3-year survival benefit of 28–95% and 17–79% in women with and without loco-regional therapy respectively. Two studies did not find any improvement in overall survival. One study found an improvement in 5-year breast cancer-specific survival of 27% with negative surgical margins versus 12% with no surgery. Three studies reported an advantage in progression-free survival in the treatment group compared with the non-treatment group. Loco-regional treatment for breast cancer patients with distant metastases at diagnosis is an important issue because of possible improvement of survival or disease-free survival. The possibility of surgery and/or radiotherapy following induction chemotherapy should be weighed and left to individual practice. Participation in randomized controlled trials should be encouraged.
Tài liệu tham khảo
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics. CA Cancer J Clin 58(2):71–96
Ries LAG, Melbert D, Krapcho M et al. (eds) SEER cancer statistics review, 1975–2004. National Cancer Institute, Bethesda. http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER Web site, 2007 gotten from the ACS Breast Cancer Facts
Biron P, Durand M, Roche H, Delozier T, Battista C, Fargeot P, Spaeth D, Bachelot T, Poiget E, Monnot F, Tanguy ML, Cure H (2008) Pegase 03: a prospective randomized phase III trial of FEC with or without high dose thiotepa, cyclophosphamide and autologous stem cell transplantation in first line treatment of metastatic breast cancer. Bone Marrow Transplant 41:555–562
Chuthapisit S, Eremin J, El-Sheemey M, Eremin O (2009) Breast cancer chemoresistance: emerging importance of cancer stem cells. Surg Oncol [Epub ahead of print]
Dean M, Fojo T, Bates S (2005) Tumor stem cells and drug resistance. Nat Rev Cancer 5:275–284
Khan SA, Stewart AK, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132:620–626
Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24:2743–2749
Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE et al (2006) Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol 13:776–782
Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA (2007) Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol 14:2187–2194
Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM (2008) Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg 247:732–738
Shien T, Kinoshita T, Shimizu C, Hojo T, Taira N, Doihara H, Akashi-Tanaka S (2009) Primary tumor resection improves the survival of younger patients with metastatic breast cancer. Oncol Rep 21:827–832
Fields RC, Jeffe DB, Trinkaus K, Zhang Q, Arthur C, Aft R et al (2007) Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site metastasis. Ann Surg Oncol 14:3345–3351
Ruiterkamp J et al. (2009) Surgical resection of the primary tumor is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol. doi:10.1016/j.ejso.2009.03.012
Hazard HW, Gorla SR, Scholtens D, Kiel K, Gradishar WJ, Khan SA (2008) Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer 113:2011–2019
Neuman H, Morrogh M, Gonen M, Van Zee K, Morrow M, King T (2008) Do patients with stage IV breast cancer and intact primary benefit from local control of the breast as a component of multimodality therapy? In: Breast cancer symposium, 5–7 Sept 2008. http://www.asco.org. Accessed 30 Sept 2008
Badwe R, Hawaldar R, Khare A, Nadkarni M, Jalali R, Parmar V (2008) Role of local-regional treatment in metastatic breast cancer at presentation: a randomized trial. In: Breast cancer symposium, 5–7 Sept 2008. http://www.asco.org. Accessed 30 Sept 2008
Le Scodan R, Stevens D, Brian E, Floiras JL, Cohen-Solal C, De La Lande B, Tubiana-Hulin M, Yacoub S, Gutierrez M, Ali D, Gardner M, Moisson P, Villette S, Lerebours F, Munck JN, Labib A (2009) Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. J Clin Oncol 27(9):1375–1381
Rao R, Feng L, Kuerer HM, Singletary E, Bedrosian I, Hunt KK, Ross MI, Hortobagyi GN, Feig BW, Ames FC, Babiera GV (2008) Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Ann Surg Oncol 15:1696–1702
Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD (2009) Effects of surgical excision on survival of patients with stage IV breast cancer. J Surg Res [Epub ahead of print]
Bafford AC, Burstein HJ, Barkley CR et al (2009) Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat 115:7–12
Cady B, Nathan NR, Michaelson JS, Golshan M, Smith BL (2008) Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol 15:3384–3395
Carmicheal AR, Anderson EDC, Chetty U, Dixon JM (2003) Does local surgery have a role in the management of stage IV breast cancer? EJSO 29:17–19
Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, Caton JR Jr, Munshi N, Crawford ED (2001) Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345(23):1655–1659
Hallissey MT, Allum WH, Roginski C, Fielding JW (1988) Palliative surgery for gastric cancer. Cancer 62(2):440–444
Bristow RE, Tomacruz RS, Armstrong DK et al (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20(5):1248–1259
Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, Millis JM, Posner MC (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135(5):530–534
Young SE, Martinez SR, Essner R (2006) The role of surgery in treatment of stage IV melanoma. J Surg Oncol 94(4):344–351
Kakarala M, Wicha MS (2008) Implications of the cancer stem-cell hypothesis for breast cancer prevention and therapy. J Clin Oncol 26(17):2813–2820
Li X, Lewis MT, Huang J, Gutierrez C, Osborne CK, Wu MF, Hilsenbeck SG, Pavlick A, Zhang X, Chamness GC, Wong H, Rosen J, Chang JC (2008) Intrinsic resistance of tumorigenic breast cancer cells to chemotherapy. J Natl Cancer Inst 100(9):672–679
Liu R, Wang X, Chen GY, Dalerba P, Gurney A, Hoey T, Sherlock G, Lewicki J, Shedden K, Clarke MF (2007) The prognostic role of a gene signature from tumorigenic breast-cancer cells. NEJM 356(3):217–226
Li HZ, Yi TB, Wu YZ (2008) Suspension culture combined with chemotherapy agents for sorting of breast cancer stem cells. BMC Cancer 8:135
Cameron D, Casey M, Press M, Lindquist D, Pienkowski T, Romieu CC et al (2008) A phase III randomized comparison of lapatinib plus capecetabine versus capecetabine alone in women with advanced breast cancer that has progressed on trastuzumab: updated efficacy and biomarker analysis. Breast Cancer Res Treat 112:533–543
Atilla S, Serdar O, Sheryl KF, Bahadir GM (2009) Randomized trial comparing locoregional resection of primary tumor with no surgery in stage IV breast cancer at the presentation (protocol MF07-01): a study of Turkish federation of the national societies for breast. Breast J 15(4):399–403
Khan SA (2007) Does resection of an intact breast primary improve survival in metastatic breast cancer? Oncology 21(8):924–931