Source: DGNews  |  Posted 2 years ago

By Wayne Kuznar

PHOENIX, Ariz -- March 10, 2009 -- Removal of the intact primary tumour is associated with improved overall survival in breast-cancer patients presenting with metastatic disease, according to research presented here at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium.

Mastectomy, furthermore, appears superior to breast-conservation techniques in this regard, said lead investigator Kandace P. McGuire, MD, Moffitt Cancer Center, Tampa, Florida, speaking here at a poster session on March 7.

In a retrospective review, Dr. McGuire and colleagues found that 1 in 3 women with stage IV breast cancer who underwent surgery was still alive after 3 years compared with only 1 in 5 who did not undergo local surgical therapy. Currently, most women with metastatic breast disease are treated with chemotherapy and radiation for local control and are not referred for surgery, said Dr. McGuire.

From a prospectively maintained database, 566 patients with stage IV breast cancer were identified between 1990 and 2007. Patient demographics, tumour characteristics, sites of metastasis, and the type of operation were collected. Adjuvant therapy, overall survival, and disease status were evaluated at the last follow-up.

Of the 566 patients, 163 (29%) underwent surgical removal of the primary tumour: 63 (38%) underwent lumpectomy, of which 61 (90%) had negative margins; and 100 (62%) underwent mastectomy. The median follow-up was 37 months, at which time 54 patients (33%) who underwent surgery were alive, compared with 81 patients (20%) who did not undergo surgery (P = .0015).

Of those undergoing surgery, only the type of surgery affected overall survival. The overall survival at the final follow-up was 25% with mastectomy versus 0% with lumpectomy (P = .0017).

"What others have not shown is that clearance of margins is important," explained Dr. McGuire. "You can't just simply remove your breast disease and hope for the best; you really need to have clear margins."

"Performing surgery on the breast in the setting of metastatic breast cancer is one of those things where people have said for years that the horse is already out of the barn, and what are you hoping to achieve? You're certainly not going to cure the patient," Dr. McGuire commented. "As others have shown, we found that in a fairly high-performing patient population [with] limited metastasis … who tolerate chemotherapy well, surgery does increase their overall survival."

"It doesn't cure them," Dr. McGuire added, "but it does give them time."

[Presentation title: Mastectomy Offers Improved Overall Survival Over Breast Conservation in Patients Presenting With Metastatic Breast Cancer. Abstract P83]