Metastasectomy versus radiation of secondary sites in stage IV breast cancer: Analysis from a national cancer registry

Abstract

Locoregional therapy at primary or secondary sites in breast cancer may be associated with improved survival as compared to systemic therapy alone. We explored the sociodemographic and clinicopathologic factors associated with the use of radiation versus surgical resection of metastatic sites (metastasectomy) in patients with de novo stage IV breast cancer, followed by the associated overall survival. Methods: We sampled the National Cancer Database for patients with de novo stage IV breast cancer, (2010e2017) and described cohort's characteristics using univariate analyses. We identified 5 subgroups based on malignant site involvement: 1. Bone only, 2. Brain only, 3. Liver only, 4. Lung only, and 5. Metastasis involving >1 site. Kaplan-Meier modeling with log-rank testing and multivariate Cox Regression analysis were used to explore differences in overall survival between those that received radiation at secondary sites and those that underwent metastasectomy. Results: N ¼ 22,749patients were included in this analysis. Radiation (81.2%) was used more commonly than metastasectomy (28.8%). Metastasectomy was associated with better median overall survival across all 5 cohorts (p < .001), with the survival benefit being the most pronounced with lung only (OS: 56.9 months; HR 0.8, 95% CI 0.7e0.9, p ¼ .032), or liver only (OS: 41.6 months; HR: 0.9; 95% CI: 0.7e1.1, p < .001) metastasis. Conclusion: Metastasectomy in patients with de novo stage IV breast cancer may be associated with improved overall survival as compared to radiation of secondary lesions, particularly in those with only liver or lung involvement. Prospective randomized controlled trials investigating surgical resection of metastatic sites in patients with breast cancer are warranted.

Metastasectomy for oligometastatic bone disease of the appendicular skeleton: A concise review

“…Koizumi et al 52 also demonstrated similar increase in survival for those with one metastatic foci, but had a higher rate of patients with solitary bone metastasis at 41%. A recent review of the United States National Cancer Database of over 22 000 patients with de novo stage IV breast cancer found that metastasectomy was associated with improved survival when compared to those treated with radiation and the bone‐metastasis‐only cohort was 31.6% of the study population 53 …”

“…A recent review of the United States National Cancer Database of over 22 000 patients with de novo stage IV breast cancer found that metastasectomy was associated with improved survival when compared to those treated with radiation and the bone-metastasisonly cohort was 31.6% of the study population. 53 In a retrospective review of 115 individuals with metastatic breast cancer to bone, Wegemer et al 55 found that patients with solitary lesions treated with wide resection had an improved survival rate. In contradistinction, Durr et al 56 found that wide resection in patients with solitary bone metastasis did not significantly improve survival, although the number of patients who received this treatment was limited (6 of 70).…”

What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

“…13 In general, the orthopedic oncology community has placed greater consideration on the benefits of en bloc resection and EPR for appendicular MBD in the appropriate clinical scenario. [13][14][15][16] Using a large retrospective dataset, we asked (1)…”

“…While survival in patients with MBD requiring orthopedic surgery has shown unclear temporal trends, 12 a recent study of femoral metastasis secondary to renal and lung carcinoma demonstrated measurable impact of biologic anti‐neoplastic agents on patient survival 13 . In general, the orthopedic oncology community has placed greater consideration on the benefits of en bloc resection and EPR for appendicular MBD in the appropriate clinical scenario 13–16 …”