Primary Loco-Regional Treatment in Metastatic Breast Cancer

See response to this letter here.


Letter to the Editor

By Hakan Buyukhatipoglu, Taner Babacan, Turgay Ulas1

1Gaziantep University School of Medicine, Medical Oncology, Gaziantep, Turkey 

To the Editors:

We read with great interest the article by Lang et al. [1]  Actually primary loco-regional treatment of metastatic breast cancer is full of debate, your present study provided one of the valuable evidences. However, in order to draw certain conclusions prospective studies are needed and we believe this study can provide some background evidence to design a prospective study particularly in certain metastatic breast cancer patients, especially in the patients with bone-only metastatic disease. When reading this nice paper some questions has arisen. As you mentioned in the text 24 patients underwent radiation therapy (RT) after mastectomy or breast conserving surgery, which we disagree for two reasons: the first one is although radiotherapy, when indicated, do reduce both mortality and local recurrence rates in the adjuvant setting, however, there is no rationale to apply RT in metastatic setting [2], secondly we believe that the metastatic breast  patients should not be treated with a curative intent because of given increased drug and radiation toxicity and low quality of life. The other issue is the groups of patients analyzed for survival are very heterogeneous; for example the group included patients of estrogen receptor positive and negative or her [2] receptor positive and negative, and of patients with only bone metastasis or visceral metastasis. In our opinion it would have been better if the groups had been analyzed separately; for example, a subset survival analyses for bone-only metastasis group and visceral metastasis group. Moreover, further analyses may be needed for these subgroups such as according to the hormone status. We would like to ask the authors if they made such an analysis. And what are author’s opinions about which groups of patients will benefit surgery; did data of this study provide any information regarding that?

References

1. Lang JE, Tereffe W, Mitchell MP, Rao R, Feng L, Meric-Bernstam F, Bedrosian I, Kuerer HM, Hunt KK, Hortobagyi GN, Babiera GV. Primary Tumor Extirpation in Breast Cancer Patients Who Present with Stage IV Disease is Associated with Improved Survival. Ann Surg Oncol. 2013; Jan 11 [Epub ahead of print]

2. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366:2087-2106.


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