Favourable long-term results after surgical removal of lung metastases of breast cancer

Abstract

We retrospectively evaluated whether a surgical strategy benefits patients with operable lung metastasis of breast cancer. Between 1960 and 2000, 90 patients (mean age 55.1; range 32-77) with lung metastasis (79 solitary, 11 multiple) underwent surgery as follows: wedge resection (n = 10), segmental resection (n = 11), lobectomy (n = 68) and pneumonectomy (n = 1). The metastases were completely resected in 89% of them. One patient died due to surgical complications. The overall 5- and 10-year cumulative overall survival rates were 54% and 40%, respectively (median, 6.3 years). Fifteen patients survived without relapse for over 10 years. They were 24% of those who progressed for 10 years or more after lung surgery. The most significant prognostic factor was disease-free interval (DFI) and stage at breast surgery. The 10-year survival rates of those with >==3 and <3 years of DFI were 47% and 26%, respectively (P = 0.014). Survival times were significantly longer for patients with clinical stage I at breast surgery than those with stage II-IV (P = 0.013). Our data, although limited and highly selective, suggest that surgical approach to lung metastasis from breast cancer may prolong survival in certain subgroups of patients to a greater extent than systemic chemotherapy alone. Surgical approach to lung metastasis of breast cancer, if possible, should be a treatment of choice to a great extent.

Lung Metastasectomy for Pulmonary Metastatic Breast Carcinoma

“…The literature search performed on 15 February 2017 had 2426 hits in MEDLINE and found one review article in the Cochrane library. After step-wise appraisal 11 studies where identified each with at least 20 patients having had lung metastasectomy following primary tumour treatment with curative intent [2][3][4][5][6][7][8][9][10][11][12].…”

“…Ten of the reviewed studies were case series, together reporting on over 971 patients with treated breast carcinoma and pulmonary metastasectomy [2][3][4][5][6][7][8][9][10][11]. Operations were performed between 1960 and 2007.…”

“…Median follow-up for the case series was between 20.6 and 102 months [4,[7][8][9][10][11]. Pulmonary metastasectomy resulted in a median post-metastasectomy survival of 32 to 96.6 months (▶ Table 2) [2][3][4][5][8][9][10][11].…”

“…Pulmonary metastasectomy resulted in a median post-metastasectomy survival of 32 to 96.6 months (▶ Table 2) [2][3][4][5][8][9][10][11]. Five-year survival rates were between 30.8 and 54.4 %, while 10-year survival rates were between 18 and 51 % [2][3][4][5][6][7][8][9][10]. One meta-analysis from the year 2015 analysed the survival prognosis of patients with breast carcinoma after lung metastasis surgery quantitatively [12].…”

“…For this prognostic factor results were heterogeneous between the studies analysed: six studies found a statistically significant influence on post-metastasectomy survival for this parameter while four author groups found no evidence for a significant influence on prognosis. Despite shortened disease-free intervals of below 36 months patients achieved a median survival of 28.8 to 34.4 months and five-year survival rates of 21 to 33.3 % following lung metastasis surgery [4,6,7,9]. Complete resectability of all lung lesions is considered to be the most important indication criterion for lung metastasis of surgery.…”