Lumpectomy or Mastectomy in Patients Presenting with Metastatic Disease

  • Georges Vlastos
  • Elisabetta Rapiti
  • Helena M. Verkooijen
  • Christine Bouchardy


Metastatic breast cancer is generally considered to be an incurable disease, and in most studies, 5-year survival rates do not exceed 20%. Anatomic site of metastases correlates with survival: 5-year survival rate for breast cancer with only soft tissue metastases is 41%, with only bone metastases 23% and for visceral metastases only 13%. Resection of the primary fusion may influence survival in this situation. This chapter provides an overview of the relative merits of resecting the primary tumor in patients with metastatic breast cancer.


Metastatic Breast Cancer Axillary Lymph Node Dissection Metastatic Breast Cancer Patient National Cancer Data Base Locoregional Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Andre F, Slimane K, Bachelot T, et al. Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol. 2004;22(16):3302–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Hortobagyi GN. Can we cure limited metastatic breast cancer ? J Clin Oncol. 2002; 20:620–3.PubMedGoogle Scholar
  3. 3.
    American Cancer Society: Cancer facts and figures. 2006. Accessed 10 Sep 2010.
  4. 4.
    National Comprehensive Cancer Network (NCCN). Prefered chemotherapy regimens for recurrent or metastatic breast cancer. Accessed 10 Sep 2010.
  5. 5.
    Beslija S, Bonneterre J, Burstein H, et al. Second consensus on medical treatment of metastatic breast cancer. Ann Oncol. 2007;18:215–25.PubMedCrossRefGoogle Scholar
  6. 6.
    Bernard-Marty C, Cardoso F, Picart MJ. Facts and controversis in systemic treatment of metastatic breast cancer. Oncologist. 2004;9:617–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Singletary SE, Walsh G, Vauthey JN, et al. A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist. 2003;8:241–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Vlastos G, Smith DL, Singetary SE, et al. Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic metastases. Ann Surg Oncol. 2004;2010:869–74.CrossRefGoogle Scholar
  9. 9.
    Elias D, Maisonnette F, Druet-Cabanac M, et al. An attempt to clarify indications for hepatetomy for liver metastases from breast cancer. Am J Surg. 2003;185:158–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Lanza LA, Natarajan G, Roth JA, et al. Long-term survival after resection of pulmonary metastases from carcinoma of the breast. Ann Thorac Surg. 1992;54:244–7.PubMedCrossRefGoogle Scholar
  11. 2010.
    Pieper DR, Hess KR, Sawaya RE. Role of surgery in the treatment of brain metastases in patients with breast cancer. Ann Surg Oncol. 1997;4:481–90.PubMedCrossRefGoogle Scholar
  12. 12.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.PubMedCrossRefGoogle Scholar
  13. 13.
    Fisher B, Anderson S, Bryant J, et al. Twenty year follow-up of a randomized trial comparing total mastectomy, lumpectomy, lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Khan A, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery. 2002;132(4):620–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Carmichael AR, Anderson ED, Chetty U, et al. Does local surgery have a role in the management of stage IV breast cancer ? Eur J Surg Oncol. 2003;29:17–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Rapiti E, Verkooijen HM, Vlastos G, et al. Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol. 2006; 24(18):2743–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Barbiera GV, Rao R, Feng L, et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and a intact primary tumor. Ann Surg Oncol. 2006; 13(6): 776–82.CrossRefGoogle Scholar
  18. 18.
    Blanchard DK, Shetty PB, Hilsenback SG, Elledge RM. Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg. 2008;247:732–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Morrow M, Goldstein L. Surgery of the primary tumor in metastatic breast cancer: closing the barn after the horse has bolted. J Clin Oncol. 2006;24(18):2634–6.CrossRefGoogle Scholar
  20. 20.
    Morrow M. Improved survival in metastatic breast cancer following total excision of the ­primary tumor. Nat Clin Pract Oncol. 2007;4(1):14–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Fisher B, Montague E, Redmond C, et al. Findings from NSABP protocol No. B-04-comparison of radical mastectomy with alternative treatments for primary breast cancer, I: radiation ­compliance and its relation to treatment outcome. Cancer. 1980;46:1–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Overgaard M et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337:949–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Clarke M et al. Effects of radiotherapy and differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;366:2087–106.PubMedGoogle Scholar

Copyright information

© Springer New York 2010

Authors and Affiliations

  • Georges Vlastos
    • 1
  • Elisabetta Rapiti
  • Helena M. Verkooijen
  • Christine Bouchardy
  1. 1.Division of GynecologyGeneva University HospitalsGenevaSwitzerland

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