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Success and Failure of Primary Medical, Nonoperative Management In Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Nonoperative but systemic therapy as first-line management is offered to some patients with breast cancer (BC) who have assumed limited life expectancy, such as older women or those who have distant metastases at initial presentation. We evaluated rates of and predicting factors for success and failure of this therapy approach.

Methods

Seventy-five patients who were initially treated only systemically, and cases in which local control while avoiding surgery was the intended long-term therapy goal were analyzed. Additionally, two stage-dependent subgroups were distinguished (A: stage I-III, n = 31; B: stage IV, n = 44). Failure of therapy was defined as when secondary surgery had to be performed due to locoregional progression or in case of no surgery when severe locoregional clinical signs/symptoms were observed during the further course.

Results

Patients in group A were older than those in group B (81 vs. 67.5 years; P < 0.001) and showed an increased survival (5-year rates: 40.2% vs. 24.3%). In 24 patients of the entire cohort (32%), secondary surgery had to be performed; surgery was performed more often in group A (58.1% vs. 13.6%). In the cases in which no surgery was performed (n = 51), 11 women (21.6%) suffered from severe locoregional symptoms in the palliative situation (A: n = 1; B: n = 10). Although the presence of stage IV was a significant factor for therapy success (odds ratio (OR), 2.59; 95% confidence interval (CI), 0.95–7.05; P = 0.039), skin involvement was associated with failure of therapy (OR, 3.57; 95% CI, 1.16–11.11; P = 0.031).

Conclusions

Nonoperative treatment may be offered to selected patients with BC who have assumed limited life expectancy. These women must be openly informed that this approach is not successful in nearly half of the cases.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Basel, Switzerland

    Seraina Margaretha Schmid MD, Aleksandra Anna Modlasiak MD, Mary Elizabeth Myrick MD, Nerbil Kilic MD & Uwe Güth MD

  2. Department of Medical Oncology, University Hospital Basel (UHB), Basel, Switzerland

    Nerbil Kilic MD

  3. Department of Surgery, UHB, Basel, Switzerland

    Carsten Thomas Viehl MD

  4. Schötzau and Simmen Institute for Biomathematics, Basel, Switzerland

    Andreas Schötzau MS

Authors
  1. Seraina Margaretha Schmid MD
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  2. Aleksandra Anna Modlasiak MD
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  3. Mary Elizabeth Myrick MD
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  4. Nerbil Kilic MD
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  5. Carsten Thomas Viehl MD
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  6. Andreas Schötzau MS
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  7. Uwe Güth MD
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Correspondence to Uwe Güth MD.

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Schmid, S.M., Modlasiak, A.A., Myrick, M.E. et al. Success and Failure of Primary Medical, Nonoperative Management In Breast Cancer. Ann Surg Oncol 18, 2166–2172 (2011). https://doi.org/10.1245/s10434-011-1592-8

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  • DOI: https://doi.org/10.1245/s10434-011-1592-8

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