Metastasectomy and surgical resection of the primary tumor in patients with stage IV breast cancer

Time for a second look?

Barbara A Pockaj, Nabil Wasif, Amylou Dueck, Dennis A Wigle, Judy C Boughey, Amy C Degnim, Richard J. Gray, Sarah A. McLaughlin, Donald W Northfelt, Robert P. Sticca, James W Jakub, Edith A. Perez

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35 Citations (Scopus)

Abstract

Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.

Original languageEnglish (US)
Pages (from-to)2419-2426
Number of pages8
JournalAnnals of Surgical Oncology
Volume17
Issue number9
DOIs
StatePublished - Sep 2010

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Metastasectomy
Breast Neoplasms
Neoplasms
Survival
Therapeutics
Drug Therapy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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title = "Metastasectomy and surgical resection of the primary tumor in patients with stage IV breast cancer: Time for a second look?",
abstract = "Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.",
author = "Pockaj, {Barbara A} and Nabil Wasif and Amylou Dueck and Wigle, {Dennis A} and Boughey, {Judy C} and Degnim, {Amy C} and Gray, {Richard J.} and McLaughlin, {Sarah A.} and Northfelt, {Donald W} and Sticca, {Robert P.} and Jakub, {James W} and Perez, {Edith A.}",
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AU - Pockaj, Barbara A

AU - Wasif, Nabil

AU - Dueck, Amylou

AU - Wigle, Dennis A

AU - Boughey, Judy C

AU - Degnim, Amy C

AU - Gray, Richard J.

AU - McLaughlin, Sarah A.

AU - Northfelt, Donald W

AU - Sticca, Robert P.

AU - Jakub, James W

AU - Perez, Edith A.

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N2 - Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.

AB - Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.

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