Indian Journal of Surgical Oncology

, Volume 10, Issue 1, pp 213–218 | Cite as

Effect of Surgery or Radiotherapy of the Breast on Survival in Metastatic Disease: a Retrospective Cohort Study

  • Mahnaz Roayaei
  • Yalda Nikanpour
  • Hoda MahdaviEmail author
Original Article


Evidence to justify survival benefit of local therapy of the breast (LT) for breast cancer patients who are metastatic at presentation (MBC) is weak. The aim of this study is to evaluate the outcome of LT on survival in MBC patients. Patients who had received (1) radiotherapy, (2) surgery, (3) surgery and radiotherapy as LT, and (4) no LT in four groups of 25 were evaluated for 1- and 4-year cause-specific survival (CSS). One- and 4-year CSS in four groups were (1) 76% and 60%, (2) 84% and 56% (3) 80% and 52%, and (4) 48% and 16%, respectively. When controlling for age and site of metastasis as covariates, grouping significantly correlated with survival: F (3, 94): 2.93, P 0.04. Post hoc analysis revealed that the mean survival of group 2: (M 23.39, SE 2.53) was higher than group 4: (M 13.63, SE 2.52, P = 0.03). Surgery as a single modality LT for MBC may provide survival benefit.


Metastatic breast cancer Local treatment Radiotherapy Surgery 



The authors of this manuscript would like to thank medical registry team and technological personnel of Omid hospital, and all patients and their families for their kind corporation.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30CrossRefGoogle Scholar
  2. 2.
    Zeichner SB, Herna S, Mani A, Ambros T, Montero AJ, Mahtani RL, Ahn ER, Vogel CL (2015) Survival of patients with de-novo metastatic breast cancer: analysis of data from a large breast cancer-specific private practice, a university-based cancer center and review of the literature. Breast Cancer Res Treat 153(3):617–624CrossRefGoogle Scholar
  3. 3.
    Pagani O, Senkus E, Wood W, Colleoni M, Cufer T, Kyriakides S, Costa A, Winer EP, Cardoso F (2010) International guidelines for management of metastatic breast cancer: can metastatic breast cancer be cured? J Natl Cancer Inst 102(7):456–463CrossRefGoogle Scholar
  4. 4.
    Otaghvar HA, Hosseini M, Tizmaghz A, Shabestanipour G, Noori H (2015) A review on metastatic breast cancer in Iran. Asian Pac J Trop Biomed 5(6):429–433CrossRefGoogle Scholar
  5. 5.
    Hosseini H, Obradović M, Hoffmann M, Harper KL, Sosa MS, Werner-Klein M, Nanduri LK, Werno C, Ehrl C, Maneck M (2016) Early dissemination seeds metastasis in breast cancer. Nature 540:552–558CrossRefGoogle Scholar
  6. 6.
    Boomsma MF, Garssen B, Slot E, Berbee M, Berkhof J, Meezenbroek EJ, Slieker W, Visser A, Meijer S, Beelen RH (2010) Breast cancer surgery-induced immunomodulation. J Surg Oncol 102(6):640–648CrossRefGoogle Scholar
  7. 7.
    Goldfarb Y, Ben-Eliyahu S (2007) Surgery as a risk factor for breast cancer recurrence and metastasis: mediating mechanisms and clinical prophylactic approaches. Breast Dis 26(1):99–114CrossRefGoogle Scholar
  8. 8.
    Katharina P (2011) Tumor cell seeding during surgery—possible contribution to metastasis formations. Cancers 3(2):2540–2553CrossRefGoogle Scholar
  9. 9.
    Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE, Hunt KK, Ross MI, Gwyn KM, Feig BW (2006) Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Ann Surg Oncol 13(6):776–782CrossRefGoogle Scholar
  10. 10.
    Cady B, Nathan N, Michaelson J, Golshan M, Smith B (2008) Matched pair analyses of stage IV breast cancer with or without resection of primary breast site. Ann Surg Oncol 15(12):3384–3395CrossRefGoogle Scholar
  11. 11.
    Carmichael A, Anderson E, Chetty U, Dixon J (2003) Does local surgery have a role in the management of stage IV breast cancer? Eur J Surg Oncol (EJSO) 29(1):17–19CrossRefGoogle Scholar
  12. 12.
    Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA (2007) Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Ann Surg Oncol 14(8):2187–2194CrossRefGoogle Scholar
  13. 13.
    Hazard HW, Gorla SR, Scholtens D, Kiel K, Gradishar WJ, Khan SA (2008) Surgical resection of the primary tumor, chest wall control, and survival in women with metastatic breast cancer. Cancer 113(8):2011–2019CrossRefGoogle Scholar
  14. 14.
    Jazayeri SB, Saadat S, Ramezani R, Kaviani A (2015) Incidence of primary breast cancer in Iran: ten-year national cancer registry data report. Cancer Epidemiol 39(4):519–527CrossRefGoogle Scholar
  15. 15.
    Khan SA, Stewart AK, Morrow M (2003, September) Does local therapy of the intact primary tumor in stage 4 breast cancer affect survival. In: Proc ASCO (Vol 22, p 81)Google Scholar
  16. 16.
    Rapiti E, Verkooijen HM, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino AP, Chappuis PO, Bouchardy C (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24(18):2743–2749CrossRefGoogle Scholar
  17. 17.
    Thomas A, Khan SA, Chrischilles EA, Schroeder MC (2016) Initial surgery and survival in stage IV breast cancer in the United States, 1988-2011. JAMA Surgery 151(5):424–431CrossRefGoogle Scholar
  18. 18.
    Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S, Budrukkar A, Mittra I, Gupta S (2015) Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol 16(13):1380–1388CrossRefGoogle Scholar
  19. 19.
    King TA, Lyman J, Gonen M, Reyes S, Hwang E-SS, Rugo HS, Liu MC, Boughey JC, Jacobs LK, McGuire KP (2016) A prospective analysis of surgery and survival in stage IV breast cancer (TBCRC 013). In: American Society of Clinical Oncology, vol 34, p 1006Google Scholar
  20. 20.
    Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan Z, Ozaslan C, Evrensel T (2016) A randomized controlled trial evaluating resection of the primary breast tumor in women presenting with de novo stage IV breast cancer: Turkish study (protocol MF07-01). In: American Society of Clinical Oncology, vol 34, p 1005Google Scholar
  21. 21.
    Sabel MS, W, J (UpToDate; 2016. Accessed 20 July 2017) The role of local therapies in metastatic breast cancer. Hayes DF, Chagpar AB (ed)
  22. 22.
    MO E, ESoMO E pocket guidelines and mobile app: ESMO; 2015 [cited 19/11/2015]Google Scholar
  23. 23.
    Network NCC (2018) Breast cancer (version 3.2018). National comprehensive cancer network guidelines. Available at Accessed 26 Oct 2018
  24. 24.
    Morrow M, Burstein HJ, Harris JR (2015) Malignant tumors of the breast: Chapter 79. In: DeVita VT, Lawre TS, Rosenberg SA (eds) DeVita, Hellman, and Rosenberg’s cancer: principles and practice of oncology, 10th edn. Lippincott Williams & Wilkins, Philadelphia Google Scholar
  25. 25.
    Blanchard DK, Shetty PB, Hilsenbeck SG, Elledge RM (2008) Association of surgery with improved survival in stage IV breast cancer patients. Ann Surg 247(5):732–738CrossRefGoogle Scholar
  26. 26.
    Rao R, Feng L, Kuerer HM, Singletary SE, Bedrosian I, Hunt KK, Ross MI, Hortobagyi GN, Feig BW, Ames FC (2008) Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Ann Surg Oncol 15(6):1696–1702CrossRefGoogle Scholar
  27. 27.
    Fields RC, Jeffe DB, Trinkaus K, Zhang Q, Arthur C, Aft R, Dietz JR, Eberlein TJ, Gillanders WE, Margenthaler JA (2007) Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site of metastasis. Ann Surg Oncol 14(12):3345–3351CrossRefGoogle Scholar
  28. 28.
    Choi SH, Kim JW, Choi J, Sohn J, Kim SI, Park S, Park HS, Jeong J, Suh CO, Keum KC, Kim YB, Lee IJ (2018) Locoregional treatment of the primary tumor in patients with de novo stage IV breast cancer: a radiation oncologist’s perspective. Clin Breast Cancer 18(2):e167–e178Google Scholar
  29. 29.
    Gultekin M, Yazici O, Eren G, Yuce D, Aksoy S, Ozisik Y, Guler N, Yazici G, Hurmuz P, Yildiz F (2014) Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma. Breast 23(6):775–783CrossRefGoogle Scholar
  30. 30.
    Le Scodan R, Stevens D, Brain E, Floiras JL, Cohen-Solal C, De La Lande B, Tubiana-Hulin M, Yacoub S, Gutierrez M, Ali D (2009) Breast cancer with synchronous metastases: survival impact of exclusive locoregional radiotherapy. J Clin Oncol 27(9):1375–1381CrossRefGoogle Scholar
  31. 31.
    Mauro GP, de Andrade Carvalho H, Stuart SR, Mano MS, Marta GN (2016) Effects of locoregional radiotherapy in patients with metastatic breast cancer. Breast 28:73–78CrossRefGoogle Scholar
  32. 32.
    Group EBCTC (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 378(9804):1707–1716CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Radiotherapy and OncologyIsfahan University of Medical SciencesIsfahanIran
  2. 2.Najaf-Abad Branch, Faculty of MedicineIslamic Azad UniversityIsfahanIran
  3. 3.Department of Radiation OncologyIran University of Medical SciencesTehranIran

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