The role of primary surgery in metastatic breast cancer at presentation

Abstract

Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, surgery for the primary tumor has been reserved for palliation. In the current era of targeted therapies there is improved survival for patients with stage IV breast cancer. Retrospective studies demonstrate that up to 50% of patients presenting with stage IV disease who undergo breast surgery appear to have a survival advantage. It is suggested that a more aggressive and multidisciplinary approach should be considered for these selected patients. The impact of local control is greatest in the presence of effective targeted therapy support. There is a need for further study to define patient subsets that will benefit from targeted therapy support and to challenge conventional thinking about the role of surgery in stage IV breast cancer, while considering a new multimodality treatment paradigm to optimize patient outcomes.

The incidence of metastatic breast disease at presentation is between 3% and 10%. Recently, encouraging reports of surgical resection of the primary tumor challenged the traditional approach of systemic therapies only in this group of patients. In this review, we aimed to discuss the hypotheses and the role of primary surgery in metastatic breast carcinoma at presentation under the guidance of published studies.