Abstract
BACKGROUND
Evolving concepts of cancer biology and emerging evidence of a potential survival benefit from local surgery have raised the question of an expanded role for surgery in select patients with metastatic breast cancer (MBC). To determine whether such developments have influenced clinical practice, the authors evaluated surgical practice patterns in the study institution over the last 15 years.
METHODS
Two institutional databases were screened to identify patients with MBC who underwent breast surgery (1990โ2005). Retrospective review was conducted to assess trends over time and to evaluate the role of surgery in the more modern era (1995โ2005).
RESULTS
The overall frequency of mastectomy remained stable over time (1.7%); however, between early (1990โ1995) and late (2000โ2005) periods the rate of โsymptom controlโ mastectomy decreased (41% to 25%), whereas the rate of โlocal controlโ mastectomy increased (34% to 66%). Conversely, the overall frequency of wideโlocal excision (WLE) increased over time (1995โ2001), from 1% to 9% (P < .001) with no differences noted between rates of symptom control or local control procedures. In the modern era (1995โ2005), 256 of 12,529 patients (2%) with MBC underwent breast surgery (33% mastectomy, 52% WLE); most frequently to โoptimize local controlโ (50%) and primarily in the setting of limited/stable distant disease. Surgery was performed for palliation in only 19% of patients. At a median followโup of 33.9 months (range, 0โ198.7 months), 136 of 256 patients (53%) in this cohort remained alive; 88% were free of local disease.
CONCLUSIONS
Although surgery in MBC has historically been reserved for palliation, the authors observed a decreasing rate of traditional โtoilet mastectomyโ and a broadened surgical approach to the asymptomatic patient. When viewed in parallel with evolving concepts in cancer biology, these data reflect a change in the traditional approach to patients with MBC and warrant further investigation. Cancer 2008. ยฉ2008 American Cancer Society.