Locoregional therapy of the primary tumour in de novo stage IV breast cancer in 216 066 patients: A meta-analysis

Abstract

Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy. However, there is mounting evidence that resection of the primary tumour and/or localised radiotherapy (locoregional therapy; LRT) could be associated with overall survival improvements. We aimed to conduct a meta-analysis to inform decision making. Using the PubMed, Cochrane and Ovid SP databases, a literature review and meta-analysis were conducted to assess the effect of LRT on overall survival. Studies were analysed for the impact of LRT on survival. All forms of LRT resulted in a significant 31.8% reduction in mortality (N = 42; HR = 0.6823 (95% CI 0.6365; 0.7314)). Surgical resection resulted in a significant 36.2% reduction in mortality (N = 37; HR = 0.6379 (95% CI 0.5974; 0.6811)). The prospective trials reported a 19.23% reduction in mortality which was not statistically significant (N = 3, HR = 0.8077 (95% CI 0.5704; 1.1438). 216 066 patients were included. This is the largest meta-analysis regarding this question to date. Our meta-analysis shows that LRT of the primary tumour seems to improve overall survival in de novo stage IV disease. Therefore, this therapeutic option should be considered in selected patients after a careful multidisciplinary discussion.

Predicting the survival benefit of local surgery in patients aged 70 years or older with stage IV breast cancer: A population-based analysis

“…Stage IV BC patients aged 70e79 years, with poorly differentiated or undifferentiated tumor, with lymph node-positive disease, who received chemotherapy, with TNBC, with married status, or with a history of benign or borderline tumors were more likely to receive LRT, which is consistent with the results of multiple retrospective analyses that patients who choose surgery may be younger, have a higher histological grade, and have fewer metastases or only have bone metastases [13]. After adjusting for confounding factors, the prognosis of the surgery group was better than that of the non-surgery group (OS, HR ¼ 0.751, 95% CI [0.668e0.843], P < 0.001.…”

Role of Locoregional Treatment in De Novo Stage IV Breast Cancer

“…As seen in other studies, the authors conclude that the treatment plans should be made in a multidisciplinary setting with LRT being strongly considered for select group of patients with favorable prognostic factors. Most recently, Gera et al 14 in 2020 published the largest meta-analysis regarding the question of LRT in de novo stage IV setting. This study showed that LRT resulted in significant 31.8% reduction in mortality, HR = 0.6823.…”

Metastatic feline mammary cancer: prognostic factors, outcome and comparison of different treatment modalities – a retrospective multicentre study

“…Several mechanisms have been proposed to explain this benefit, such as the disruption of self-seeding of the primary tumour, cancer stem cell elimination and overall reduction tumour burden. [37][38][39][40] Tumour manipulation can also lead to tumour cell destruction and releasing tumour-associated antigens into circulation, improving immune response by an abscopal effect. 41 As 57.5% of cats had local mammary disease at diagnosis and 12% of cats developed new mammary tumours and/or local metastatic disease after the diagnosis, local resection may be suggested and necessary to improve the quality of life, especially in ulcerated and aggressive local disease.…”