Medline ® Abstracts for References 1-3
of 'The role of local therapies in metastatic breast cancer'
Infiltrating breast carcinoma in patients age 30 years and younger: long term outcome for life, relapse, and second primary tumors.
Lee CG, McCormick B, Mazumdar M, Vetto J, Borgen PI
Int J Radiat Oncol Biol Phys. 1992;23(5):969.
A retrospective study examining the influence of young age, defined as 30 years or less on the outcome of early-staged (American Joint Committee 1978-I, II) breast cancer was undertaken using patients treated between 1950 and 1970 to ensure a long follow-up period. Because of the era of treatment, radical mastectomy without systemic chemotherapy was the predominant treatment. Ninety-nine patients met study criteria, with a median follow-up of 11.4 years (range 0.5 to 41 years). The patient group was compared to patients of all ages, treated at Memorial Sloan-Kettering Cancer Center in 1960 (5 and 10 years) and to patients treated between 1940 and 1943 (30 year follow-up). At the 5, 10, and 30 year follow-up periods, patients in the young age group consistently had disease-specific survival 10-20% lower than their older counterparts. For young patients who survived their first cancer diagnosis, second primaries both in the contralateral breast and elsewhere, played a significant role in determining their subsequent life span. When compared to risks of second primary cancers in the National Cancer Institute's SEER (Surveillance, Epidemiology and End Results Program) Cancer Registry for all ages, the increased risk for very young breast cancer patients was significant (p = 0.000). With these two findings in mind, treatment for young patients with breast cancer should focus not on local therapy options alone but on the increased risk of both systemic disease and of second primaries.
Dept. of Radiation Oncology, Memorial Sloan-Kettering Cancer, New York, NY 10021.
Survival after first recurrence of breast cancer. The Miami experience.
Vogel CL, Azevedo S, Hilsenbeck S, East DR, Ayub J
BACKGROUND: Four hundred thirty-three patients with recurrent breast cancer were treated by the authors at a large medical breast oncology facility from 1976-1982. The median survival time from first relapse (MSFR) for the 193 patients whose survival experience was not confounded by lead-time bias was 26 months. This MSFR is similar to that of most series published in the 1970s and 1980s and is approximately double that of series published in the 1960s.
METHODS: In this series, regression analysis identified disease-free interval (DFI), estrogen receptor (ER) status, and dominant disease site as significant prognostic variables, similar to other published series.
RESULTS: In 113 patients with known ER values, DFI, and dominant metastatic sites, a prognostic spectrum of MSFR patterns was identified among combinations of these three variables. The MSFR ranged from 15 months for poor risk patients with negative ER values, visceral dominant sites, and DFI of less than 24 months, to more than 90 months for good risk patients with positive ER values, soft tissue dominant sites, and DFI of more than 24 months. Although menopausal status alone was not a significant prognostic variable in regression analysis, 66% of premenopausal patients had a constellation of "poor" prognostic variables.
CONCLUSIONS: This type of prognostic factor analysis at first relapse could help identify subsets of patients who might be considered for aggressive investigational therapies such as high-dose chemotherapy with autologous bone marrow reconstitution.
Papanicolaou Comprehensive Cancer Center, University of Miami School of Medicine, Florida.
Effects of surgical excision on survival of patients with stage IV breast cancer.
Leung AM, Vu HN, Nguyen KA, Thacker LR, Bear HD
J Surg Res. 2010;161(1):83.
BACKGROUND: Non-palliative resection of the primary tumor in stage IV breast cancer is controversial. Our aim was to determine whether surgery improves survival in stage IV patients.
METHODS: We reviewed records of all stage IV breast cancer patients (1990-2000) at our institution. Data collection included demographics, metastasis sites, treatment, and survival. Survival was compared between metastasis type, hormonal therapy versus no hormonal therapy, chemotherapy versus no chemotherapy, radiation versus no radiation, and surgery versus no surgery. To ascertain local therapy effects while accounting for chemotherapy, we analyzed survival among chemotherapy alone versus chemotherapy with radiation versus chemotherapy with surgery. We also performed multivariate analysis by multiple linear regression.
RESULTS: Of 157 patients, 58 (37%) had bone-only metastases, 99 (63%) had visceral metastases. Both groups had a 17-mo median survival. Eighty (51%) received hormonal therapy while 77 (49%) did not. Both groups had a 15-mo median survival. Eighty-four (54%) received chemotherapy with a 25-mo median survival versus 8 mo for 73 (46%) not receiving chemotherapy, Wilcoxon (P<0.0001), and log-rank (P = 0.02). Fifty-eight (37%) received radiation and 99 (63%) did not, with both groups having a 17-mo median survival. Fifty-two (33%) with surgery to the breast primary had a 25-mo median survival, while 105 (67%) without surgery had a 13-mo median survival, Wilcoxon (P = 0.004) and log-rank (P = 0.06). Among patients receiving chemotherapy, 37 with chemotherapy alone had a 21-mo median survival versus 40 mo for the 14 with chemotherapy and radiation and 22 mo for the 33 with chemotherapy and surgery. These differences were not significant by Wilcoxon (P = 0.41) or log-rank (P = 0.36). Multivariate analysis determined chemotherapy as the only factor associated with improved survival (P = 0.02).
CONCLUSION: Our data, when standardized for chemotherapy, suggests loco-regional therapy does not improve survival.
Department of Surgery, Massey Cancer Center, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia 23298-0568, USA. email@example.com