another long-held dogma of the oncologists may have to bite the dust

[Lani]

For those who are Stage IV at the time breast cancer is diagnosed--Why haven't they been looking critically at this before?

1: Ann Surg Oncol. 2006 Apr 17; [Epub ahead of print] Links

Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary Tumor.

Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE, Hunt KK, Ross MI, Gwyn KM, Feig BW, Ames FC, Hortobagyi GN.

Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA, gvbabiera@mdanderson.org.

BACKGROUND: Currently, therapy for breast cancer patients with stage IV disease and an intact primary tumor is metastasis directed; the primary tumor is treated only when it causes symptoms. A recent review suggested that surgery may improve long-term survival in such patients. We evaluated the effect of surgery in such patients on long-term survival and disease progression. METHODS: We reviewed the records of all breast cancer patients treated at our institution between 1997 and 2002 who presented with stage IV disease and an intact primary tumor. Information collected included demographics, tumor characteristics, site(s) of metastases, type/date of operation, use of radiotherapy, chemotherapy and hormonal therapy, disease progression (time to progression and location of progression) in the first year after diagnosis, and last follow-up. Overall and metastatic progression-free survival were compared between surgery and nonsurgery patients. RESULTS: Of 224 patients identified, 82 (37%) underwent surgical extirpation of the primary tumor (segmental mastectomy in 39 [48%] and mastectomy in 43 [52%]), and 142 (63%) were treated without surgery. The median follow-up time was 32.1 months. After adjustment for other covariates, surgery was associated with a trend toward improvement in overall survival (P = .12; relative risk, .50; 95% confidence interval, .21-1.19) and a significant improvement in metastatic progression-free survival (P = .0007; relative risk, .54; 95% confidence interval, .38-.77). CONCLUSIONS: Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival. Prospective studies are needed to validate these findings.

PMID: 16614878 [PubMed - as supplied by publisher]For

[kk1]

Thanks Lani!

This is a great article, there has been very little published. When I was DX at primary with stageIV I struggled to decided if I should have surgery or not. My surgeon and my Onc. both said there was very little guidance and few studies.

In the end my surgeon convinced me to have surgery and and glad I did now that I see this study. Today is actually my 2nd year aniversary from my DX as stage IV...I've been NED for 18 months. yipee

kk1

[Lani]

AS THEY ALWAYS ADD TO THE END OF ARTICLES WHICH PURPORT TO SHOW SOMETHING NEW--"THIS NEEDS TO BE VALIDATED IN LARGER PROSPECTIVE STUDIES"--IE, THEY ARE TRYING TO COVER THEIR BEHINDS IN THE CASE IT DOESN'T PROVE TRUE IN LARGER NUMBERS

BUT IT WAS DONE AT A PRESTIGIOUS INSTITUTION WITH EXCELLENT FOLLOW-UP AND IS THE BEST WE HAVE FOR NOW--AT LEAST WE HAVE IT!

WHO KNOWS WHY THEY DIDN'T LOOK AT THIS CRITICALLY BEFORE.

IT JUST SHOWS YOU TO ASK QUESTIONS! Glad this helped

With all the bad news going wrong I am editing what I post in hopes of not scaring people further (I thought twice about posting this-- I rationalized it this way:what if a member did not have the surgery, but then there might be someone else who was deciding whether to have surgery or not and the benefit of having some good information, or just information, on which to base a life-determining decision, seemed to outwear some temporary fear in someone who already had fear and imaginings without information)

It seems getting information (even if it later turns out not to be true, which is always possible) seems to always win out in my book.

One can always choose NOT to read my posts!

[sassy]

Lani,

I always appreciate your posts. Knowledge is power, best sooner than later, but always better than lack of knowledge. I don't always have the time or expertise to research as I would like, so I really appreciate all the information that others present. It has certainly helped me become more knowledgable and has helped me and my oncologist in my journey thru this labyrinth.

So thanks to you and everyone else who bring information to the board.

Sassy
________
CumIn5Mins live

[Becky]

This was a good post Lani. Maryanne and I saw a speaker in February who did mention that the tide is turning on how to deal with a Stage IV patient's primary breast tumor. In the past, it was just left as is and other treatment besides surgery was employed. However, now it seems that a thoughtful review is done. Oncologists take into consideration how much metastatic disease is present and if the patient can withstand the surgery as well as recovery that is quick enough to resume chemo and other treatments.


Thanks again for a great post.

Becky

[Sherryg683]

Thanks Lani, I had my primiary tumor removed but at the time, they didn't know I was going to be stage IV. Glad that little sucker is gone. It was only 1.5 cm , so I guess the figured I wouldn't have any mets...sherryg683