Medline ® Abstract for Reference 53
of 'The role of local therapies in metastatic breast cancer'
Hepatic Resection or Ablation for Isolated Breast Cancer Liver Metastasis: A Case-control Study With Comparison to Medically Treated Patients.
Sadot E, Lee SY, Sofocleous CT, Solomon SB, Gönen M, Peter Kingham T, Allen PJ, DeMatteo RP, Jarnagin WR, Hudis CA, D'Angelica MI
Ann Surg. 2016 Jul;264(1):147-54.
OBJECTIVE: To evaluate the efficacy of surgical treatment for patients with isolated breast cancer liver metastases (BCLM).
BACKGROUND: Single-arm retrospective studies have shown promising results associated with surgery for isolated BCLM; however, this treatment remains controversial and its role is not well-defined.
METHODS: A review of 2150 patients with BCLM who underwent treatment in a single institution was conducted, and 167 (8%) patients with isolated BCLM were identified. A case-control study was conducted to compare outcomes in patients with isolated BCLM who underwent surgery and/or ablationto patients who underwent conventional medical therapy.
RESULTS: A total of 167 patients were included (surgery/ablation: 69; medical: 98), with a median follow-up for survivors of 73 months. Patients in the surgical cohort more frequently had estrogen receptor-positive tumors and received adjuvant chemotherapy and radiotherapy for their primary breast tumor. The hepatic tumor burden was less and the interval from breast cancer diagnosis to BCLM was significantly longer (53 vs 30 months) in the surgical cohort. Patients undergoing surgical treatment had a median recurrence-free interval of 28.5 months (95% confidence interval (CI): 19-38) with 10 patients (15%) recurrence free after 5 years. There was no significant difference in overall survival (OS) between the surgical and medical cohorts (median OS: 50 vs 45 months; 5-year OS: 38% vs 39%).
CONCLUSIONS: Hepatic resection and/or ablation was not associated with a survival advantage. However, significant recurrence-free intervals can be accomplished with surgical treatment. Surgical intervention might be considered in highly selected patients with the goal of providing time off of systemic chemotherapy.
*Departments of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY†Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore‡Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY§Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY||Department of Medicine, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY.