Could Local Surgery Improve Survival in Stage IV Breast Cancer?

Background: Metastatic breast cancer (Stage IV) accounts for 3% of all newly 
diagnosed patients with breast cancer in Japan, which is not different from that 
of USA (6%) reported according to the Surveillance, Epidemiology and End 
Results data. The treatment of Stage IV breast cancer has traditionally been 
palliative care with chemotherapy, hormonal therapy and/or radiation therapy. 
Young patients with limited metastatic (oligometastatic) disease and an 
excellent performance status tend to be long-term survivors. Combined 
treatment for such patients including surgery, provide better chance for longterm progression-free survival than systemic therapy alone.
Objective: Evaluating overall survival and progression free survival for 
metastatic breast cancer patients underwent mastectomy plus systemic therapy 
versus that on systemic therapy alone.
Patients and methods: This randomized study was conducted in surgical 
oncology department, medical oncology department, South Egypt Cancer 
Institute, Assiut University. We prospectively review and compare women 
presented with metastatic breast cancer between from January 2014 and 
December 2020, who received primary tumor resection (group A) and women 
treated non-operatively (group B).
Results: This study was conducted in surgical oncology department, medical 
oncology department -South Egypt Cancer Institute, Assiut University. we 
retrospectively and prospectively review and compare women (200 patients) 
presented with metastatic breast cancer between January 2014 and December 
2019, who received surgery to the breast and women treated non-operatively. 
The study includes 67 patients who underwent surgery (42 patients underwent 
primary surgery then systemic treatment the others 25 patients received 1ry 
systemic treatment then underwent surgery) and 133 patients received only 
systemic treatment. Overall survival and progression free survival was 63.0% 
and 58.5% respectively, mean time of OS was28.1100 ± 1.3012 with range of 6 
– 60 months and mean time of PFS was 26.0700 ± 1.3110 with range of 5 – 57 
months.
Conclusion: Historically the standard treatment for metastatic breast cancer was 
systemic therapy and surgical resection of primary tumor was specified for 
palliation but with advanced understanding of tumor microbiology and animal 
module studies extent of surgery in advanced breast cancer increases.