A Role for Curative Surgery in the Treatment of Selected Patients with Metastatic Breast Cancer

Abstract

Learning Objectives: After completing this course, the reader will be able to: Explain how surgery in combination with systemic therapy may offer significantly improved survival outcomes in selected patients with metastatic breast cancer. Appreciate the value of chest x-rays in follow-up to identify patients with pulmonary or sternal metastases who may be candidates for surgical resection. Recognize that the concept of a “cure” in breast cancer is evolving to mean a prolonged period of survival without significant symptoms. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Although metastatic breast cancer is widely believed to carry a grim prognosis, treatment developments over the past 25 years have greatly improved survival outcomes in these patients. In selected cases, aggressive treatment approaches may occasionally result in long-term survival of 15 years or more. This review considers the role of surgery in the treatment of single or multiple metastatic lesions restricted to one site. For each site, available literature from 1992–2002 was assessed to determine the role of surgery on survival outcomes and to determine appropriate criteria for selecting the best candidates for surgery. For lung, liver, brain, and sternum metastases, the use of surgery with or without adjuvant therapy resulted in greater median survival times and 5-year survival rates. The best candidate for surgery had no evidence of additional metastatic disease, good performance status, and a long disease-free interval after treatment of the primary tumor. Current treatment standards for breast cancer follow-up do not include imaging studies other than mammography. The addition of chest x-rays as part of routine follow-up should be considered as a cost-effective approach for early assessment of metastases to the lung or sternum that may be appropriate for surgical excision.