Reviewing Best Practices in the Surgical Management of Breast Cancer: Post-Surgery Outcomes in Stage IV Disease

In this final episode of OncChats: Reviewing Best Practices in the Surgical Management of Breast Cancer, Gladys Giron, MD, FACS, and Cristina Lopez-Peñalver, MD, both of Baptist Health South Florida, shed light on clinical outcomes following surgery of the primary tumor in patients with stage IV breast cancer.

Lopez-Peńalver: Before we close out, I have one final question for you. Do you mind expanding on the clinical outcomes after surgery of the primary tumor in stage IV disease?

Giron: This is a topic that does come up quite frequently at our multidisciplinary tumor board and other discussions that we have. I will discuss the data regarding surgical removal of the primary tumor in patients with proven metastatic disease.

A prospective randomized study is probably the one that is most well-known and most quoted. Basically, this was a study that was performed by Atilla Soran, MD, MPH, FACS, in Turkey, and it found that there was a benefit in 5-year survival of [patients with] stage IV breast cancer who were treated with resection of the primary tumor. In contrast, an American Registry study did not demonstrate improved survival. Our practice is to individualize the treatment. As Dr Lopez-Peńalver mentioned earlier, most commonly we perform surgery on patients in this setting when we need to achieve local control and palliation.

Also, of great importance is the ability to work together with our reconstructive surgeons because, at times, these masses can be quite large, ulcerated, and fungated and take up a majority of the breast itself and the chest wall. An adequate excision would require, again, tissue rearrangements, sometimes skin grafting or flaps, to allow for closure. I would also like to add that it is very important in our discussions with the patients, their families, and our colleagues in other specialties, that this surgery is not going to be performed for cure. These patients are going to undergo surgery so that we may improve their quality of life. Often, this will then be followed—if allowed by the patient’s medical condition and if appropriate—[by] radiation therapy to further palliate their symptoms and to decrease the risk that we may have recurrence of that local disease in spite of their metastatic disease. As long as we know what our goals are, we can achieve outcomes that are satisfactory, both to the patient and family and to the medical team.

It has been a pleasure to speak with you, Dr Lopez-Peñalver, about the treatment of [patients with] stage III and IV breast cancer. Thank you for your time, and thank you to the audience for tuning in, as well.

Lopez-Peńalver: Thank you.