| Título: | Excision of the primary tumour in patients with metastatic breast cancer: a clinical dilemma |
| Autores: |
Samiee, S.; University of Ottawa and the Ottawa Hospital Cancer Centre Berardi, P.; University of Ottawa and Ottawa General Hospital Bouganim, N.; University of Ottawa and the Ottawa Hospital Cancer Centre Vandermeer, L.; University of Ottawa and the Ottawa Hospital Cancer Centre Arnaout, A.; University of Ottawa and Ottawa General Hospital Dent, S.; University of Ottawa and the Ottawa Hospital Cancer Centre Mirsky, D.; Queensway Carleton Hospital, Ottawa Chasen, M.; University of Ottawa and the Ottawa Hospital Cancer Centre Caudrelier, J.M.; University of Ottawa and the Ottawa Hospital Cancer Centre Clemons, M.; University of Ottawa and the Ottawa Hospital Cancer Centre |
| Fecha: | 2012-08-02 |
| Publicador: | Multimed Inc. |
| Fuente: |
Ver documento |
| Tipo: |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| Tema: | Metastatic breast cancer; surgery; local excision |
| Descripción: | Background Approximately 10% of new breast cancer patients will present with overt synchronous metastatic disease. The optimal local management of those patients is controversial. Several series suggest that removal of the primary tumour is associated with a survival benefit, but the retrospective nature of those studies raises considerable methodologic challenges. We evaluated our clinical experience with the management of such patients and, more specifically, the impact of surgery in patients with synchronous metastasis. Methods We reviewed patients with primary breast cancer and concurrent distant metastases seen at our centre between 2005 and 2007. Demographic and treatment data were collected. Study endpoints included overall survival and symptomatic local progression rates. Results The 111 patients identified had a median follow-up of 40 months (range: 0.6–71 months). We allocated the patients to one of two groups: a nonsurgical group (those who did not have breast surgery, n = 63) and a surgical group (those who did have surgery, n = 48, 29 of whom had surgery before the metastatic diagnosis). When compared with patients in the nonsurgical group, patients in the surgical group were less likely to present with T4 tumours (23% vs. 35%), N3 nodal disease (8% vs. 19%), and visceral metastasis (67% vs. 73%). Patients in the surgical group experienced longer overall survival (49 months vs. 33 months, p = 0.01) and lower rates of symptomatic local progression (14% vs. 44%, p < 0.001). Conclusions In our study, improved overall survival and symptomatic local control were demonstrated in the surgically treated patients; however, this group had less aggressive disease at presentation. The optimal local management of patients with metastatic breast cancer remains unknown. An ongoing phase III trial, E2108, has been designed to assess the effect of breast surgery in metastatic patients responding to first-line systemic therapy. If excision of the primary tumour is associated with a survival benefit, then the preselected subgroup of patients who have responded to initial systemic therapy is the desired population in which to put this hypothesis to the test. |
| Idioma: | Inglés |
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