De novo Stage IV Luminal Breast Cancer: Yes or No for Local Treatment? Serial Cases and Review

Marija Karakolevska-Ilova; Elena Simeonovska Joveva; Aleksandar Serafimov

doi:10.3889/oamjms.2021.6052

Authors

Marija Karakolevska-Ilova Department of Oncology, Faculty of Medical Sciences, University Goce Delchev Shtip, Clinical Hospital Shtip, Shtip, Macedonia https://orcid.org/0000-0001-7353-2110
Elena Simeonovska Joveva Department of Neurology, Faculty of Medical Sciences, University Goce Delchev Shtip, Clinical Hospital Shtip, Shtip, Macedonia
Aleksandar Serafimov Department of Cardiology, Faculty of Medical Sciences, University Goce Delchev Shtip, Clinical Hospital Shtip, Shtip, Macedonia https://orcid.org/0000-0003-3638-1397

DOI:

https://doi.org/10.3889/oamjms.2021.6052

Keywords:

Primary metastatic breast cancer, Local treatment, Overall survival

Abstract

BACKGROUND: Primary stage IV breast cancer accounts about of 3–5% of newly diagnosed breast cancer cases. The management of this patient subset mostly comprises systemic therapy, with additional surgery or radiotherapy to control locoregional symptoms. Some of the retrospective studies showed the benefit of locoregional treatment as the first treatment of choice for overall survival (OS), but the efficacy of primary site surgery remains controversial for OS in prospective, controlled trials.

AIM: We aimed to presents series of cases with primary metastatic breast cancer with diffuse bone metastasis.

MATERIALS AND METHODS: This study was serial of cases with primary metastatic breast cancer with diffuse bone metastasis and a review of the literature. All of the cases were treated with upfront surgical resection of the primary in the breast.

RESULTS: During the follow-up period of 36 months, all of our patients were still alive.

CONCLUSION: Retrospective studies about resection of primary tumor as the first treatment of choice are with conflicting results, which may be related to randomization bias, including different biological types of breast cancer, different metastatic sites, and patients with different menopausal status. On the other hand, prospective studies did not show any powerful results that would lead the treatment in de novo stage IV breast cancer because of few limitations such a short follow-up period (between 23 and 40 months), younger patients, ER-positive/HER2 negative tumors, and type of chemotherapy given or not upfront. The effect of upfront surgery in newly metastatic breast cancer patients is still challenging, so there is a need to identify the exact cohort of patients who could benefit from surgery.

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