Advertisement

Readdressing the Role of Surgery of the Primary Tumor in de Novo Stage IV Breast Cancer

  • Seema Ahsan KhanEmail author
  • Elizabeth S. M. DesJardin
Chapter
Part of the Cancer Treatment and Research book series (CTAR, volume 173)

Abstract

The impressive advances in breast cancer treatment observed in recent years also apply to the metastatic setting, where a subset of patients with favorable metastatic disease enjoy long-term survival with systemic therapy. In patients with distant disease, the primary tumor in the breast has not classically been though to merit specific locoregional therapy. However, about 6% of Stage IV patients in the USA and up to 20% in limited resource environments present with synchronous distant metastases at the time of initial diagnosis. For this group, who have an intact primary tumor, retrospective studies suggest that local therapy for the primary site may be beneficial. However, these retrospective analyses are biased in that women receiving local therapy to the primary site were younger and had biologically favorable tumors and lower volume metastatic disease. Two completed randomized clinical trials have shown conflicting results, and others are ongoing. In this chapter, we discuss the results of these studies through the present day and summarize their conclusions and their implications for clinical management.

Keywords

Stage IV breast cancer Local therapy Locoregional therapy Surgery Metastatic breast cancer Survival 

References

  1. 1.
    Hortobagyi GN (2002) Can we cure limited metastatic breast cancer? J Clin Oncol 20:620–623CrossRefPubMedGoogle Scholar
  2. 2.
    Nieto Y, Nawaz S, Jones RB et al (2002) Prognostic model for relapse after high-dose chemotherapy with autologous stem-cell transplantation for stage IV oligometastatic breast cancer. J Clin Oncol 20:707–718CrossRefPubMedGoogle Scholar
  3. 3.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30CrossRefPubMedGoogle Scholar
  4. 4.
    Andre F, Slimane K, Bachelot T et al (2004) Breast cancer with synchronous metastases: trends in survival during a 14-year period. J Clin Oncol 22:3302–3308CrossRefPubMedGoogle Scholar
  5. 5.
    Thomas A, Khan SA, Chrischilles EA, Schroeder MC (2016) Initial surgery and survival in stage IV breast cancer in the United States, 1988–2011. JAMA Surg 151:424–431CrossRefPubMedGoogle Scholar
  6. 6.
    Gradishar WJ, Anderson BO, Balassanian R et al (2015) Breast cancer version 2.2015. J Natl Compr Canc Netw 13:448–475CrossRefPubMedGoogle Scholar
  7. 7.
    Khan SA (2007) Does resection of an intact breast primary improve survival in metastatic breast cancer? Oncology (Williston Park) 21:924–931Google Scholar
  8. 8.
    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 20:1248–1259CrossRefPubMedGoogle Scholar
  9. 9.
    Samarasam I, Chandran BS, Sitaram V et al (2006) Palliative gastrectomy in advanced gastric cancer: is it worthwhile? ANZ J Surg 76:60–63CrossRefPubMedGoogle Scholar
  10. 10.
    Lim S, Muhs BE, Marcus SG et al (2007) Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol 95:118–122CrossRefPubMedGoogle Scholar
  11. 11.
    Ruo L, Gougoutas C, Paty PB et al (2003) Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 196:722–728CrossRefPubMedGoogle Scholar
  12. 12.
    Flanigan RC, Salmon SE, Blumenstein BA et al (2001) Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345:1655–1659CrossRefPubMedGoogle Scholar
  13. 13.
    Mickisch GH, Garin A, van PH et al (2001) Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 358:966–970CrossRefPubMedGoogle Scholar
  14. 14.
    Chang SJ, Hodeib M, Chang J, Bristow RE (2013) Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis. Gynecol Oncol 130:493–498CrossRefPubMedGoogle Scholar
  15. 15.
    Comen EA (2012) Tracking the seed and tending the soil: evolving concepts in metastatic breast cancer. Discov Med 14:97–104PubMedGoogle Scholar
  16. 16.
    Norton L, Massague J (2006) Is cancer a disease of self-seeding? Nat Med 12:875–878CrossRefPubMedGoogle Scholar
  17. 17.
    Karnoub AE, Dash AB, Vo AP et al (2007) Mesenchymal stem cells within tumour stroma promote breast cancer metastasis. Nature 449:557–563CrossRefPubMedGoogle Scholar
  18. 18.
    Danna EA, Sinha P, Gilbert M et al (2004) Surgical removal of primary tumor reverses tumor-induced immunosuppression despite the presence of metastatic disease. Cancer Res 64:2205–2211CrossRefPubMedGoogle Scholar
  19. 19.
    Gunduz N, Fisher B, Saffer EA (1979) Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res 39:3861–3865PubMedGoogle Scholar
  20. 20.
    Fisher B, Gunduz N, Coyle J et al (1989) Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res 49:1996–2001PubMedGoogle Scholar
  21. 21.
    Perletti G, Concari P, Giardini R et al (2000) Antitumor activity of endostatin against carcinogen-induced rat primary mammary tumors. Cancer Res 60:1793–1796PubMedGoogle Scholar
  22. 22.
    Khan SA, Stewart AK, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132:620–626CrossRefPubMedGoogle Scholar
  23. 23.
    Rapiti E, Verkooijen HM, Vlastos G et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24:2743–2749CrossRefPubMedGoogle Scholar
  24. 24.
    Gnerlich JJ, D.B., A.D. D, Beers C et al (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(8):2187–2194Google Scholar
  25. 25.
    Ruiterkamp J, Ernst MF, LV vdP-F et al (2009) Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. Eur J Surg Oncol 35(11):1146–1151. doi: 10.1016/j.ejso.2009.03.012
  26. 26.
    Dominici L, Najita J, Hughes M et al (2011) Surgery of the primary tumor does not improve survival in stage IV breast cancer. Breast Cancer Res Treat 129:459–465CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Babiera GV, Rao R, Feng L 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 13:776–782CrossRefPubMedGoogle Scholar
  28. 28.
    Rao R, Feng L, Kuerer HM et al (2008) Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Ann Surg Oncol 15:1696–1702CrossRefPubMedGoogle Scholar
  29. 29.
    Neuman HB, Morrogh M, Gonen M et al (2010) Stage IV breast cancer in the era of targeted therapy: does surgery of the primary tumor matter? Cancer 116:1226–1233CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Barkley CR, Bafford AC, Burstein HJ et al (2007) Breast surgery for women presenting with stage IV breast cancer. In: Breast cancer research and treatment SABCS 2007Google Scholar
  31. 31.
    Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM (2008) Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg 247:732–738CrossRefPubMedGoogle Scholar
  32. 32.
    Hazard HW, Gorla SR, Kim J et al (2007) Surgical resection of the primary tumor in stage IV breast cancer and survival. Surg Oncol 14:1–128CrossRefGoogle Scholar
  33. 33.
    Fields RC, Jeffe DB, Trinkaus K 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 of metastasis. Ann Surg Oncol 14(12):3345–3351Google Scholar
  34. 34.
    Leung AM, Vu HN, Nguyen KA et al (2010) Effects of surgical excision on survival of patients with stage IV breast cancer. J Surg Res 161:83–88CrossRefPubMedGoogle Scholar
  35. 35.
    Shien T, Kinoshita T, Shimizu C et al (2009) Primary tumor resection improves the survival of younger patients with metastatic breast cancer. Oncol Rep 21:827–832PubMedGoogle Scholar
  36. 36.
    Pathy NB, Verkooijen HM, Taib NA et al (2011) Impact of breast surgery on survival in women presenting with metastatic breast cancer. Br J Surg 98:1566–1572CrossRefPubMedGoogle Scholar
  37. 37.
    Le Scodan R, Stevens D, Brain E et al (2009) Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. J Clin Oncol 27:1375–1381CrossRefPubMedGoogle Scholar
  38. 38.
    Nguyen DH, Truong PT, Alexander C et al (2012) Can locoregional treatment of the primary tumor improve outcomes for women with stage IV breast cancer at diagnosis? Int J Radiat Oncol Biol Phys 84:39–45CrossRefPubMedGoogle Scholar
  39. 39.
    Perez-Fidalgo JA, Pimentel P, Caballero A et al (2011) Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes? Breast 20:548–554CrossRefPubMedGoogle Scholar
  40. 40.
    Cady B, Nathan NR, Michaelson JS et al (2008) Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol 15:3384–3395CrossRefPubMedGoogle Scholar
  41. 41.
    Ruiterkamp J, Voogd AC, Bosscha K et al (2011) Presence of symptoms and timing of surgery do not affect the prognosis of patients with primary metastatic breast cancer. Eur J Surg Oncol 37:883–889CrossRefPubMedGoogle Scholar
  42. 42.
    Hazard HW, Gorla SR, Scholtens D et al. (2008) Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer 15:113(8):2011–2019. doi:  10.1002/cncr.23870
  43. 43.
    Hartmann S, Reimer T, Gerber B, Stachs A (2014) Primary metastatic breast cancer: the impact of locoregional therapy. Breast Care (Basel) 9:23–28CrossRefGoogle Scholar
  44. 44.
    Ruiterkamp J, Voogd AC, Bosscha K et al (2011) Presence of symptoms and timing of surgery do not affect the prognosis of patients with primary metastatic breast cancer. Eur J Surg Oncol 37:883–889CrossRefPubMedGoogle Scholar
  45. 45.
    Badwe R, Hawaldar R, Nair N et al (2015) Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol 16:1380–1388CrossRefPubMedGoogle Scholar
  46. 46.
    Shien T, Nakamura K, Shibata T et al (2012) A randomized controlled trial comparing primary tumour resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (PRIM-BC): Japan Clinical Oncology Group Study JCOG1017. Jpn J Clin Oncol 42:970–973CrossRefPubMedGoogle Scholar
  47. 47.
    Ruiterkamp J, Voogd AC, Tjan-Heijnen VC et al (2012) SUBMIT: systemic therapy with or without up front surgery of the primary tumor in breast cancer patients with distant metastases at initial presentation. BMC Surg 12:5CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Cardoso F, Costa A, Norton L et al (2014) ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Breast 23:489–502CrossRefPubMedGoogle Scholar
  49. 49.
    King TA LJ, Gonen M et al (2016) A prospective analysis of surgery and survival in stage IV breast cancer. In J Clin Oncol; ASCO annual conference 2016. Annual Meeting June 4, 2016: Abstract 1006Google Scholar
  50. 50.
    Soran A, Ozbas S, Kelsey SF, Gulluoglu BM (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 Diseases. Breast J 15:399–403CrossRefPubMedGoogle Scholar
  51. 51.
    Soran A OV, Ozbas S et al (2016) A randomized controlled trial evaluating resection of the primary breast tumor in women presenting with de novo stage IV breast cancer. J Clin Oncol; 34 ASCO 2016. Annual Meeting June 4, 2016: Abstract 176Google Scholar
  52. 52.
    Fitzal FGM, Steger G, Singer CF, Marth C, Hubalek M et al (2017) Primary operation in synchronous metastasized breast cancer patients: first oncologic outcomes of the prospective randomized phase III ABCSG28 POSYTIVE trial. In: ASCO Chicago 2017. Annual Meeting June 3, 2017: Abstract 1074Google Scholar
  53. 53.
    Perez CB, Khan SA (2011) Local therapy for the primary breast tumor in women with metastatic disease. Clin Adv Hematol Oncol 9:112–119PubMedGoogle Scholar
  54. 54.
    Theriault RL, Carlson RW, Allred C et al (2013) Breast cancer, version 3.2013: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 11:753–760; quiz 761Google Scholar
  55. 55.
    King TA, Lyman JP, Gonen M et al (2016) Prognostic impact of 21-gene recurrence score in patients with stage IV breast cancer: TBCRC 013. J Clin Oncol 34:2359–2365CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Seema Ahsan Khan
    • 1
    Email author
  • Elizabeth S. M. DesJardin
    • 2
  1. 1.Robert H. Lurie Comprehensive Cancer CenterChicagoUSA
  2. 2.Northwestern McGaw Medical CenterChicagoUSA

Personalised recommendations