Surgery for Lung Mets?
This is a really interesting summary from MedWire about a study from Dr Oh and colleagues in Korea that looked at the value of surgery for removal of lung mets in selected women with Stage Iv/advanced breast cancer. Women who had four or fewer known lung mets (there can always be others that are too small to be seen on scans) who underwent this surgery had a much increased four year overall survival: 82.1% vs 32.6%.
This surgery is so different from the accepted standard practice (where surgery is very rarely suggested for any kind of metastatic cancer, the assumption being that the disease is spread beyond what can be visualized on scans and surgery has risks and impacts quality of life in a negative way) that I spoke with my husband, who is a medical oncologist, before writing this blog. He said something like this: "I am intrigued but skeptical about this study. There are so many possible confounding factors and many characteristics of a particular tumor influence how well a woman can do. Plus, this is big surgery that would be a major undertaking for a woman in this situation." Obviously, the primary caveat is to discuss this with your doctor.
Here is the summary:
Pulmonary metastasectomy may prolong breast cancer survival
By Laura Dean
18 June 2010
Cancer 2010; 116: 2890-2901
MedWire News: Pulmonary metastasectomy is a reasonable treatment option for patients with breast cancer and a limited number of isolated lung metastases, study findings indicate.
"It is generally accepted that local treatment of primary or metastatic lesions, that is primary tumor resection or metastasectomy, provides no survival advantage once systemic metastasis has occurred," say Do-Youn Oh (Seoul National University Hospital, Korea) and colleagues.
However, the benefit of local treatment in systemic metastasis is emerging for some kinds of malignancies, note the researchers.
In the present study, Oh and team reviewed the clinical outcomes for 45 patients with recurrent breast cancer and less than four lung metastases. The patients received systemic treatment alone (n=30) or pulmonary metastasectomy followed by systemic treatment (n=15).
The researchers report that patients in the pulmonary metastasectomy group had a significantly higher 3-year progression-free survival (PFS) rate, at 55%, than patients in the non-metastasectomy group, at 4.5%. Similarly, the 4-year overall survival rate was significantly higher for patients who underwent pulmonary metastasectomy compared with those who did not, at 82.1% versus 31.6%.
Multivariate analysis revealed that a disease-free interval (DFI) of less than 24 months (hazard ratio [HR]=5.43), no pulmonary metastasectomy (HR=9.52), and human epithelial growth factor receptor-2 positive (HR=3.00) and triple negative (HR=3.92) subtypes were independently associated with shorter PFS.
An extended analysis of the survival difference between patients with four or more metastases (n=95) and those with less than four metastases revealed that patients with less than four metastases who underwent pulmonary metastasectomy had a significantly longer PFS than patients with four or more metastases, regardless of whether the latter group underwent metastasectomy or not.
Writing in the journal Cancer, Oh and co-authors conclude: "Pulmonary metastasectomy can be a reasonable treatment option in patients with a small volume of metastasis despite poor prognosis characteristics." "Further prospective studies are warranted to evaluate the role of pulmonary metastasectomy," they add.