Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer
Stage IV breast cancer is the state in which the cancer has spread to distant sites , for example , the brain, liver, lung, bones. Treatment for stages I to III of breast cancer include surgery, chemotherapy and radiation therapy to the chest wall/ breast. However, treatment for women with stage IV breast cancer is chemotherapy or hormone therapy and radiation therapy for bones. In these women the role of surgery of the breast tumour was questioned in the past. Prior to our study there were only retrospective studies or animal studies looking at this question and they had conflicting results.
The study conducted by Badwe et al, randomly assigned 350 women with stage IV breast cancer to undergo surgery of the breast tumour followed by radiation therapy to the breast or chest wall. Thus half the women underwent surgery of the breast tumour and half did not. All women received either chemotherapy or hormone therapy or both as is standard practice for stage IV breast cancer. The study results suggest that there is no benefit of removing the primary breast tumour in women with stage IV breast cancer. Additionally when the breast tumor is removed in cases where there is evidence that cancer has spread to other organs, the disease in the other organs may grow.
In women with stage IV breast cancer , surgery of the breast tumour is reserved for situation when there are signs of bleeding or fungation of the tumor. This is the first large randomised study, which has conclusively shown no benefit of surgery for women with Stage IV breast cancer.
Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial.
Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S, Budrukkar A, Mittra I, Gupta S
Lancet Oncol. 2015 Sep 9. pii: S1470-2045(15)00135-7