389 - Surgical resection of locally advanced primary tumor in patients with distant metastatic breast cancer at diagnosis: results of a retrospective comp...
|Date||28 September 2012|
|Event||ESMO Congress 2012|
|Topics|| Breast Cancer, Metastatic
Surgery and/or Radiotherapy of Cancer
S. Arifi1, R. Najib2, Z. Benbrahim3, Y. Akasbi4, S. Elfakir5, N. Mellas2, A. Melhouf6, A. Banani6, O. El Mesbahi2
Women with metastatic breast cancer (MBC) with intact locally advanced primary tumors (LAT) present aggressive local symptoms that may warrant palliative surgery to the breast. However, it is unclear if such surgery otherwise improves clinical outcome. The aim of this study is to demonstrate if surgery of the breast may avoid uncontrolled chest wall disease and may improve survival.Methods
We reviewed the records of all MBC patients presented with intact LAT, treated at our institution between 2007 and 2011.We compared two groups of patients: surgical group versus nonsurgical group. Clinical outcome was assessed in the two groups. Prognostic factors affecting loco regional relapse, were evaluated.Results
75 patients were identified. The mean patient age was 49 ± 12.15 years. 52% were pre menopausal women. 87.1 % of tumors were hormone receptors positive. Her2 was assessed in 59 cases and was positive in 33.9%. Inflammatory breast cancer presented 16 %. Clinical lymph node involvement was noted in 58.7% cases. 69.6% had visceral metastasis and 5.3 % had brain metastasis. 89.3% have good Performans Status ≤ 1. All women received systemic therapy. First-line therapy consisted of anthracycline-based regimen (95.6%) and Taxane (39.7%). Among patients with HER2 positive 36.4% received Trastuzumab. Only 14% of patients with bone metastasis received bisphosphonate. 49.3% underwent mastectomy while 50.7% had intact LAT. The two groups were well balanced regarding demographics, clinicals, and tumors, characteristics. Among women who underwent mastectomy 48.5% had axillary lymph node dissection, and excision margins were positive in 25% cases. Loco regional radiotherapy (LRRT) was given to 8 women. pCR occurred in 7 patients among those who were operated. Local recurrence (LR) occurred in 9 patients (28.1%). Median time to local relapse was 3 months (2-19). LR was related to excision margin (p = 0.0001) and LRRT (p = 0.04). Median PFS was 10 months in nonsurgical group patients versus 16.5 months in surgical group.Conclusions
MBC patients with locally advanced breast cancer who underwent mastectomy had improvement in local symptoms when the excision margin was in sano. However, the impact of this surgery in survival is not clear.Disclosure
All authors have declared no conflicts of interest.