Patients with metastatic breast cancer have traditionally been considered incurable with conventional treatment. However, 5–10% of those patients survive more than 5 years, and 2–5% survive more than 10 years. Recent studies suggest that the survival of patients with metastatic breast cancer has been slowly improving. In this review, we examine the possible curative approach for a certain group of patients with metastatic breast cancer. We identify that patients most likely to benefit from such an aggressive approach are young and have good performance status, adequate body functional reserve, long disease-free interval before recurrence, oligometastatic disease, and low systemic tumor load. An aggressive multidisciplinary approach including both local treatment of macroscopic disease and systemic treatment of microscopic disease can result in prolonged disease control in certain patients with metastatic breast cancer. Whether patients with prolonged disease control are “cured” remains controversial.

Improvement of survival and prospect of cure in patients with metastatic breast cancer

Aim To analyze surgical treatment of breast cancer liver metastases (BCLM) regarding selection criteria, outcome and prognostic parameters Methods We searched Embase and Medline for all studies published 1999–2010 Results Resection was associated with a median survival (MOS) of 20–67 months and 5-year survival of 21–61% Local ablation also had a favorable outcome; MOS was 30–60 months and 5-year survival 27–41% Regarding selection, no specific limits regarding the number and size of BCLM can be given Features of the primary breast cancer (BC) were not significant for the prognosis Microscopically radical (R0) resection is a positive prognostic factor, while the effects of disease interval, hormone receptor status and response to preoperative chemotherapy were divergent The presence of EHD had a negative effect on survival in some studies, but failed to have so in other studies Conclusions Surgical therapy may benefit a subset of patients with BCLM Resection may be indicated, if an RO-resection can be done with a low risk of mortality Liver resection in the presence of extrahepatic disease remains controversial, while patients with BCLM and bone metastases could possibly be managed differently than other EHD

/pdf/liver-resection-and-local-ablation-of-breast-cancer-liver-4o1evdu5x8.pdf

Liver resection and local ablation of breast cancer liver metastases--a systematic review.

Despite the development of modern chemotherapeutics and target-specific drugs as well as improved surgical techniques, prognosis of metastatic breast cancer remains poor. Only a small number of selected patients will be eligible for liver resection and/or alternative metastatic ablation. Data on prognostic factors for patients with surgically resectable liver metastases of breast cancer are scarce at present. From 1997 to 2010, 50 patients with hepatic metastases of breast cancer have undergone laparotomy with the intention to undergo a curative liver resection at our institution. Data from these patients were collected in a prospectively maintained standardized liver resection data base. Liver resection was performed in 34 patients. Resection margins were clear in 21 cases (R0). Nine patients lived for more than 60 months after liver resection. The observed 5-year survival rate was 21 % for all 50 patients, 28 % for resected patients and 38 % after R0-resection. On univariate analysis, survival rates of the resected patients were statistically significantly influenced by R-classification, age, extrahepatic tumour at the time of liver resection, size of metastases and HER2 expression of liver metastases. Multivariate analysis revealed absence of HER2 expression, presence of extrahepatic tumour and patient’s age ≥50 years as independent factors of poor prognosis. Breast cancer patients younger than 50 years with technically resectable hepatic metastases, minimal extrahepatic tumour and positive HER2 expression appear to be suitable candidates for liver resection with curative intent. An aggressive multi-disciplinary management of those patients including surgical treatment may improve long-term survival.

Liver resection in selected patients with metastatic breast cancer: a single-centre analysis and review of literature.

Systematic review of early and long-term outcome of liver resection for metastatic breast cancer: Is there a survival benefit?

Breast cancer (BC) is the most common cancer among women worldwide. It has been estimated that approximately 12–20 % of patients will develop liver metastases from breast cancer (BCLM) and that in approximately 5 % of cases the liver is the only metastatic site. Patients with isolated BCLM have the poorest prognosis with a median survival ranging from 19 to 26 months. A total of 26 women with isolated BCLM and without any sign of disease progression after a cycle of chemotherapy were retrospectively reviewed. Women were treated with hepatic resection (HR) for unilobar disease or surgical “open” RFA for bilobar disease. Data were collected on either original BC or BCLM and from patients follow-up. Overall survival from BC diagnosis was 47.69 ± 22.25 months (range 33–84, median 45.5 months); it was 52.25 ± 14.57 months (range 33–84, median 48.5 months) for the HR patients and 43.79 ± 27.14 months (range 9–101, median 39 months) for the RFA patients. Overall survival from BCLM treatment was 21.12 ± 12.78 months (range 9–64, median 15.5 months); in detail it was 29.42 ± 14.53 months (range 12–64, median 29.5 months) for the resected patients and 14 ± 4.45 months (range 9–24, median 13.5 months) for patients treated by RFA with a strongly significant survival difference for operated patients (p = 0.001). Overall disease-free survival from BCLM was 15.96 ± 13.16 months (range 3–64, median 12 months), disease-free survival for resected patients was 23.22 ± 16.2 months (range 8–64, median 18.5 months), and for patients treated by RFA was 9.64 ± 4.22 months (range 3–18, median 9 months; Fig. 1). Overall 1, 2, and 5 years (actuarial) survival was respectively 80.7, 57, and 31 %. Given in details for the two groups, they were respectively 100, 66.6 and 34 % (actuarial) for the resected group patients and 64.2, 21.4, and 11.5 % (actuarial) for the RFA patients.
 Aggressive treatment on isolated BCLM may improve survival for these patients

Aggressive treatment for hepatic metastases from breast cancer: results from a single center.

Background The prognosis of patients with hepatic metastases (HM) from breast cancer receiving no treatment is extremely poor. The aim of this study is to report results of liver resections for breast cancer liver metastases. Methods Retrospective analysis of 17 women who underwent hepatic metastasectomy with curative intent in the Centre Leon-Berard in Lyon and in the Department of General Surgery of University of Genoa. Results The mean number of HM was 2.2 (range: 1-9). The following resections were performed: extended hepatectomies (7), hepatectomies (5), lobectomies (2) and segmentectomies (3). The median number of resected segments was 3 (range: 1-5). Perioperative complications occurred in only 1 patient (hepatic venous hypertension). Postoperative complications were seen in 5 patients: pleural effusion (3), pneumonia and fever (1) and biliary fistula (1). Nine patients developed recurrence disease: 6 patients died and 3 underwent a 2nd hepatic resection. One-year survival after hepatic resection was 92%, 2-year survival was 85%, 3-year survival was 52% and 5-year survival was 41% (Kaplan-Meier estimate). Conclusions Our data, although limited, suggest that liver resection is a viable treatment option for selected patients that can be performed safely. It should be considered in individual patients if the operative risk is low, if no extrahepatic disease is present and provided a complete resection with clear margins is technically feasible.

Surgical treatment of liver metastases from breast cancer.

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Surgical treatment of liver metastases from breast cancer.