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Rangarajan K, Lazzereschi L, Votano D, Hamady Z. Breast cancer liver metastases: systematic review and time to event meta-analysis with comparison between available treatments. Ann R Coll Surg Engl 2023; 105:293-305. [PMID: 35175853 PMCID: PMC10066639 DOI: 10.1308/rcsann.2021.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The current gold standard treatment for breast cancer liver metastases (BCLM) is systemic chemotherapy and/or hormonal therapy. Nonetheless, greater consideration has been given to local therapeutic strategies in recent years. We sought to compare survival outcomes for available systemic and local treatments for BCLM, specifically surgical resection and radiofrequency ablation. METHODS A review of the PubMed (MEDLINE), Embase and Cochrane Library databases was conducted. Data from included studies were extracted and subjected to time-to-event data synthesis, algorithmically reconstructing individual patient-level data from published Kaplan-Meier survival curves. FINDINGS A total of 54 studies were included, comprising data for 5,430 patients (surgery, n=2,063; ablation, n=305; chemotherapy, n=3,062). Analysis of the reconstructed data demonstrated survival rates at 1, 3 and 5 years of 90%, 65.9% and 53%, respectively, for the surgical group, 83%, 49% and 35% for the ablation group and 53%, 24% and 14% for the chemotherapy group (p<0.0001). CONCLUSION Local therapeutic interventions such as liver resection and radiofrequency ablation are effective treatments for BCLM, particularly in patients with metastatic disease localised to the liver. Although the data from this review support surgical resection for BCLM, further prospective studies for managing oligometastatic breast cancer disease are required.
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Affiliation(s)
| | - L Lazzereschi
- University Hospital Southampton NHS Foundation Trust, UK
| | - D Votano
- Ashford & St. Peter’s Hospitals NHS Foundation Trust, UK
| | - Z Hamady
- Ashford & St. Peter’s Hospitals NHS Foundation Trust, UK
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Ueno T. Surgical Management of Metastatic Breast Cancer: A Mini Review. Front Oncol 2022; 12:910544. [PMID: 35600412 PMCID: PMC9114738 DOI: 10.3389/fonc.2022.910544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 12/17/2022] Open
Abstract
Breast cancer with distant metastases is a systemic disease. While systemic therapies are the main treatment strategy, locoregional therapy for metastatic breast cancer (MBC) is generally palliative only. However, recent progress in systemic and local therapies has improved the prognosis of patients with MBC and some may expect long-term survival. More vigorous local therapies for MBC may, therefore, be clinically justified in selected patients. A number of clinical trials and studies have investigated the clinical significance of surgical therapy for primary tumors and distant metastases in patients with MBC. Four prospective randomized trials and multiple retrospective studies have investigated the benefit of surgical resection of primary lesions in patients with MBC, with conflicting results. There have been a number of case-control studies examining the impact of surgical resection of distant metastases, but the benefit of this approach in terms of survival is controversial because selection bias is unavoidable in retrospective studies. The present review discusses the state of the literature relating to local management of the primary breast cancer through surgical resection and surgical management of distant metastatic lesions including pulmonary and liver metastases with future perspectives.
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Affiliation(s)
- Takayuki Ueno
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Delsa H, Mounsif S, Benslima N, Mahi M, Rouibaa F. Cataclysmic Gastrointestinal Hemorrhage: Dreaded Complication of Metastatic Breast Cancer. Cureus 2022; 14:e25149. [PMID: 35733494 PMCID: PMC9205458 DOI: 10.7759/cureus.25149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
Upper gastrointestinal bleeding (UGIB) from variceal rupture is a serious condition that can be life-threatening in some cases. Usually, the main cause is portal hypertension in cirrhosis, but other etiologies like liver metastases can be also involved. We present the case of a 64-year-old woman, with a history of metastatic breast cancer, who was admitted for a massive UGIB due to ruptured esophageal varices related to portal hypertension.
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Affiliation(s)
- Hanane Delsa
- Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Sara Mounsif
- Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Najwa Benslima
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Mohamed Mahi
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Fedoua Rouibaa
- Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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Qin H, Wu YQ, Lin P, Gao RZ, Li X, Wang XR, Chen G, He Y, Yang H. Ultrasound Image-Based Radiomics: An Innovative Method to Identify Primary Tumorous Sources of Liver Metastases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1229-1244. [PMID: 32951217 DOI: 10.1002/jum.15506] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To develop radiomic models of B-mode ultrasound (US) signatures for determining the origin of primary tumors in metastatic liver disease. METHODS A total of 254 patients with a diagnosis of metastatic liver disease were included in this retrospective study. The patients were divided into 3 groups depending on the origin of the primary tumor: group 1 (digestive tract versus non-digestive tract tumors), group 2 (breast cancer versus non-breast cancer), and group 3 (lung cancer versus other malignancies). The patients in each group were allocated to a training or testing set (a ratio of 8:2). The region of interest of liver metastasis was determined through manual differentiation of the tumors, and radiomic signatures were acquired from B-mode US images. Optimal features were selected to develop 3 radiomic models using multiple-dimensionality reduction and classifier screening. The area under the curve (AUC) of the receiver operating characteristic curve was applied to assess each model's performance. RESULTS A total of 5936 features were extracted, and 40, 6, and 14 optimal features were sequentially identified for the development of radiomic models for groups 1, 2, and 3, respectively, with training set AUC values of 0.938, 0.974, and 0.768 and testing set AUC values of 0.767, 0.768, and 0.750. The differences in age, sex, and number of liver metastatic lesions varied greatly between the 4 primary tumors (P < .050). CONCLUSIONS B-mode US radiomic models could be effective supplemental means to identify the origin of hepatic metastatic lesions (ie, unknown primary sites).
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Affiliation(s)
- Hui Qin
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Quan Wu
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Peng Lin
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rui-Zhi Gao
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin Li
- Department of Life Sciences, GE Healthcare, Shanghai, China
| | - Xin-Rong Wang
- Department of Life Sciences, GE Healthcare, Shanghai, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yun He
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hong Yang
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Scharll Y, Ianetti-Hackl C, Bale R. Stereotactic Radiofrequency Ablation of Breast Cancer Liver Metastases: Short- and Long-Term Results with Predicting Factors for Survival. Cardiovasc Intervent Radiol 2021; 44:1184-1193. [PMID: 33825059 PMCID: PMC8249280 DOI: 10.1007/s00270-021-02820-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Purpose To evaluate safety, local oncological control, long-term outcome and potential prognostic factors of stereotactic RFA (SRFA) for the treatment of BCLMs. Methods Between July 2003 and December 2019, 42 consecutive female patients with median age 54.0 years were treated with SRFA at our institution for 110 BCLMs in 48 ablation sessions. Median tumor size was 3.0 cm (0.8–9.0). Eighteen (42.9%) patients had extrahepatic metastasis at initial SRFA. Results Technical success rate was 100%, i.e., all coaxial needles were inserted with appropriate accuracy within 10 mm off plan and 107/110 (92.3%) BCLMs were successfully ablated at initial SRFA. Four Grade 1 (8.3%, 4/48) and one Grade 2 (2.1%, 1/48) complications occurred. No perioperative deaths occurred. Local recurrence developed in 8 of 110 tumors (7.3%). Overall survival (OS) rates of all patients at 1, 3, and 5 years from the date of the first SRFA were 84.1%, 49.3%, and 20.8% with a median OS of 32.3 months. Univariable cox regression analyses revealed age > 60 years and extrahepatic disease (without bone only metastases) as significant predictors of worse OS (p = 0.013 and 0.025, respectively). Size and number of metastases, hormone receptor status and time onset did not significantly affect OS after initial SRFA. Conclusions SRFA is a safe, minimally invasive treatment option in the management of BCLMs, especially in younger patients without advanced extrahepatic metastasis, including those with large liver tumors.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Edward Johnston
- Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Claudia Ianetti-Hackl
- Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria.
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Bai XM, Yang W, Zhang ZY, Jiang AN, Wu W, Lee JC, Chen MH, Yan K. Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia 2018; 35:183-193. [PMID: 30200791 DOI: 10.1080/02656736.2018.1488279] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the long-term efficacy and prognostic factors of ultrasound-guided percutaneous radiofrequency ablation (RFA) for breast cancer liver metastasis (BCLM). METHODS Between 2000 and 2015, 69 patients who underwent ultrasound-guided percutaneous RFA for BCLM and had regular follow-up examinations were included. All patients had undergone resection of the primary breast cancer and had received chemotherapy, endocrine therapy or both after surgery. The sample included two males and 67 females with an average age of 50.3 ± 10.0 years (31-76 y). The mean maximum diameter of metastatic lesions in the liver was 2.9 ± 1.4 cm (1.0-6 cm). Thirty-five patients had a single metastasis, while 34 patients had multiple liver metastases (2-5 lesions). Survival results were generated using Kaplan-Meier estimates and a multivariate analysis was performed using the Cox regression model. RESULTS In total, 92 RFA sessions were performed and 135 BCLM lesions were treated. Major complications occurred in one of the 92 sessions (1.1%). Technical efficacy was achieved in 92.6% of lesions (125/135 lesions). Local tumor progression occurred in 11.6% (8/69) of patients and new intrahepatic metastasis occurred in 55.1% (38/69) of patients. From the time of initial RFA, the median overall survival was 26 months, and the one-, two-, three- and five -year survival rates were 81.8, 50.1, 25.3 and 11.0%, respectively. Based on the multivariate analysis, the following three factors were identified as independent prognostic factors for overall survival: tumor size (p = .017), positive estrogen receptor status (p = .009) and extrahepatic metastatic disease (p = .001). The median progression-free survival was 24 months, and the one-, two-, three- and five -year survival rates after RFA were 77.4, 47.0, 23.7 and 8.5%, respectively. Additionally, the independent prognostic factors for progression-free survival included tumor size (p = .011), ER positivity (p = .001), margin size (p = .017) and extrahepatic metastatic disease (p < .001). CONCLUSION The results of this study showed that RFA is a safe and locally effective method for the treatment of BCLM, especially in patients with lesions measuring less than 3 cm in diameter, a single liver metastasis, positive estrogen receptor status and no extrahepatic metastases. Also, patients with margin size >10 mm had no local tumor progression.
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Affiliation(s)
- Xiu-Mei Bai
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Yang
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Zhong-Yi Zhang
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - An-Na Jiang
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Wu
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Jung-Chieh Lee
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Min-Hua Chen
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
| | - Kun Yan
- a Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound , Peking University Cancer Hospital and Institute , Beijing , China
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Ruiz A, van Hillegersberg R, Siesling S, Castro-Benitez C, Sebagh M, Wicherts DA, de Ligt KM, Goense L, Giacchetti S, Castaing D, Morère J, Adam R. Surgical resection versus systemic therapy for breast cancer liver metastases: Results of a European case matched comparison. Eur J Cancer 2018; 95:1-10. [PMID: 29579478 DOI: 10.1016/j.ejca.2018.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/17/2018] [Accepted: 02/20/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted but not offered as therapeutic option. New evidence of the additional value of surgery in these patients is scarce while prognoses without surgery remains poor. PATIENTS AND METHODS For this case matched analysis, all nationally registered patients with BCLM confined to the liver in the Netherlands (systemic group; N = 523) were selected and compared with patients who received systemic treatment and underwent hepatectomy (resection group; N = 139) at a hepatobiliary centre in France. Matching was based on age, decade when diagnosed, interval to metastases, maximum metastases size, single or multiple tumours, chemotherapy, hormonal or targeted therapy after diagnosis. Based on published guidelines, palliative systemic treatment strategies are similar in both European countries. RESULTS Between 1983 and 2013, 3894 patients were screened for inclusion. Overall median follow-up was 80 months (95% CI 70-90 months). The median, 3- and 5-year overall survival of the whole population was 19 months, 29% and 19%, respectively. The resection and systemic group had median survival of 73 vs. 13 months (P < 0.001), respectively. Three and 5-year survival was 18% and 10% for the systemic group and 75% and 54% for the resection group, respectively. After matching, the resection group had a median overall survival of 82 months with a 3- and 5-year overall survival of 81% and 69%, respectively, compared with a median overall survival of 31 months in the systemic group with a 3- and 5-year overall survival of 32% and 24%, respectively (HR 0.28, 95% CI 0.15-0.52; P < 0.001). CONCLUSIONS For patients with BCLM, liver resection combined with systemic treatment results in improved overall survival compared to systemic treatment alone. Liver resection should be considered in selected cases.
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Affiliation(s)
- A Ruiz
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - C Castro-Benitez
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Department of Surgery, Hospital Mexico, San José, Costa Rica
| | - M Sebagh
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - D A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - K M de Ligt
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Giacchetti
- Inserm, Université Paris-Sud, Inserm U 935, Villejuif, France; Centre des maladies du sein, AP-HP, Hôpital Saint Louis, Villejuif, France
| | - D Castaing
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Inserm, Université Paris-Sud, Inserm U 1193, Villejuif, France
| | - J Morère
- AP-HP Hôpital Paul Brousse, Département de Cancérologie, Villejuif, France
| | - R Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Inserm, Université Paris-Sud, Inserm U 935, Villejuif, France
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Ruiz A, Sebagh M, Wicherts DA, Castro-Benitez C, van Hillegersberg R, Paule B, Castaing D, Vibert E, Cunha AS, Cherqui D, Morère JF, Adam R. Long-term survival and cure model following liver resection for breast cancer metastases. Breast Cancer Res Treat 2018; 170:89-100. [PMID: 29464535 PMCID: PMC5993851 DOI: 10.1007/s10549-018-4714-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Long-term survival is still rarely achieved with current systemic treatment in patients with breast cancer liver metastases (BCLM). Extended survival after hepatectomy was examined in a select group of BCLM patients. PATIENTS AND METHODS Hepatectomy for BCLM was performed in 139 consecutive patients between 1985 and 2012. Patients who survived < 5 years were compared to those who survived ≥ 5 years from first diagnosis of hepatic metastases. Predictive factors for survival were analyzed. Statistically cured, defined as those patients who their hazard rate returned to that of the general population, was analyzed. RESULTS Of the 139, 43 patients survived ≥ 5 years. Significant differences between patient groups (< 5 vs. ≥ 5 years) were mean time interval between primary tumor and hepatic metastases diagnosis (50 vs. 43 months), mean number of resected tumors (3 vs. 2), positive estrogen receptors (54% vs. 79%), microscopic lymphatic invasion (65% vs. 34%), vascular invasion (63% vs. 37%), hormonal therapy after resection (34% vs. 74%), number of recurrence (40% vs. 65%) and repeat hepatectomy (1% vs. 42%), respectively. The probability of statistical cure was 14% (95% CI 1.4-26.7%) in these patients. CONCLUSIONS Hepatectomy combined with systemic treatment can provide a chance of long-term survival and even cure in selected patients with BCLM. Microscopic vascular/lymphatic invasion appears to be a novel predictor for long-term survival after hepatectomy for BCLM and should be part of the review when discussing multidisciplinary treatment strategies.
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Affiliation(s)
- Aldrick Ruiz
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France.
| | - Mylène Sebagh
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Dennis A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Carlos Castro-Benitez
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Department of Surgery, Hospital Mexico, San José, Costa Rica
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Bernard Paule
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Denis Castaing
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Université Paris-Sud, UMR-S 785, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
- Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
- Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
- Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
| | - Jean-François Morère
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
- Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
- Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
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Fairhurst K, Leopardi L, Satyadas T, Maddern G. The safety and effectiveness of liver resection for breast cancer liver metastases: A systematic review. Breast 2016; 30:175-184. [PMID: 27764727 DOI: 10.1016/j.breast.2016.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 08/11/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023] Open
Abstract
Breast cancer liver metastases have traditionally been considered incurable and any treatment given therefore palliative. Liver resections for breast cancer metastases are being performed, despite there being no robust evidence for which patients benefit. This review aims to determine the safety and effectiveness of liver resection for breast cancer metastases. A systematic literature review was performed and resulted in 33 papers being assembled for analysis. All papers were case series and data extracted was heterogeneous so a meta-analysis was not possible. Safety outcomes were mortality and morbidity (in hospital and 30-day). Effectiveness outcomes were local recurrence, re-hepatectomy, survival (months), 1-, 2-, 3-, 5- year overall survival rate (%), disease free survival (months) and 1-, 2-, 3-, 5- year disease free survival rate (%). Overall median figures were calculated using unweighted median data given in each paper. Results demonstrated that mortality was low across all studies with a median of 0% and a maximum of 5.9%. The median morbidity rate was 15%. Overall survival was a median of 35.1 months and a median 1-, 2-, 3- and 5-year survival of 84.55%, 71.4%, 52.85% and 33% respectively. Median disease free survival was 21.5 months with a 3- and 5-year median disease free survival of 36% and 18%. Whilst the results demonstrate seemingly satisfactory levels of overall survival and disease free survival, the data are of poor quality with multiple confounding variables and small study populations. Recommendations are for extensive pilot and feasibility work with the ultimate aim of conducting a large pragmatic randomised control trial to accurately determine which patients benefit from liver resection for breast cancer liver metastases.
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Affiliation(s)
- Katherine Fairhurst
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
| | - Lisa Leopardi
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
| | - Thomas Satyadas
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
| | - Guy Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, 5011, Australia.
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Ruiz A, Wicherts DA, Sebagh M, Giacchetti S, Castro-Benitez C, van Hillegersberg R, Paule B, Castaing D, Morère JF, Adam R. Predictive Profile-Nomogram for Liver Resection for Breast Cancer Metastases: An Aggressive Approach with Promising Results. Ann Surg Oncol 2016; 24:535-545. [PMID: 27573523 DOI: 10.1245/s10434-016-5522-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast cancer liver metastases (BCLM) are considered the most lethal compared with other sites of metastases in patients with breast cancer. This study aimed to evaluate the outcome after hepatectomy for BCLM within current multidisciplinary treatment and to develop a clinically useful nomogram to predict survival. METHODS Between January 1985 and December 2012, 139 consecutive female patients underwent liver resection for BCLM at the authors' institution. Clinicopathologic data were collected and analyzed for survival outcome with determination of prognostic factors. A nomogram to predict survival was developed based on a multivariate Cox model. The predictive performance of the model was assessed according to the C-statistic and calibration plots. RESULTS After a median follow-up period of 55 months, the overall 3- and 5-year survival rates after hepatectomy were respectively 58 and 47 %. The median overall survival period was 56 months, and the median disease-free survival period after surgical resection was 33 months. A single hepatic metastasis, no triple negative tumors, no microscopic vascular invasion, and perioperative hormonal or targeted therapy were related to improved overall survival. The model achieved good discrimination and calibration, with a C-statistic of 0.80. CONCLUSIONS Liver resection for selected patients with breast cancer metastases can provide significant survival benefit. It should be part of a multidisciplinary treatment program in experienced liver surgery centers. The authors' nomogram facilitates personalized assessment of prognosis for these patients.
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Affiliation(s)
- Aldrick Ruiz
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Mylène Sebagh
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Sylvie Giacchetti
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France
| | - Carlos Castro-Benitez
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, Hospital Mexico, San José, Costa Rica
| | | | - Bernard Paule
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France
| | - Jean-François Morère
- Département de Cancérologie, AP-HP Hôpital Paul Brousse, Villejuif, France.,Université Paris-Sud, UMR-S 785, 94804, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. .,Université Paris-Sud, UMR-S 785, 94804, Villejuif, France.
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11
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Charalampoudis P, Mantas D, Sotiropoulos GC, Dimitroulis D, Kouraklis G, Markopoulos C. Surgery for liver metastases from breast cancer. Future Oncol 2016; 11:1519-30. [PMID: 25963429 DOI: 10.2217/fon.15.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Liver metastases from breast cancer (BCLM) confer poor survival. Liver resection in BCLM patients has been increasingly employed. AIM We undertook a systematic review to evaluate the role of hepatic resection in patients with breast cancer metastatic to the liver. MATERIALS & METHODS In total, 36 studies were overviewed. Patient populations, characteristics, morbidity, mortality and survival were documented. RESULTS Median overall survival was 41 months. Major morbidity was rare while 30-day postoperative mortality was near nil. CONCLUSION Liver surgery for BCLM can be performed with low mortality, acceptable morbidity and promising survival benefit in carefully selected patients.
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Affiliation(s)
- Petros Charalampoudis
- Breast Unit, Second Propedeutic Department of Surgery, Laiko General Hospital, Athens University School of Medicine, Athens, Greece
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12
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Hazrah P, Sharma D, Borgharia S, Kumar P, Lal R. Appraisal of Laparoscopic Liver Resection in the Treatment of Liver Metastasis with Special Reference to Outcome in Colorectal Malignancies. Indian J Surg 2015; 76:392-401. [PMID: 26396473 DOI: 10.1007/s12262-013-0944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022] Open
Abstract
Treatment of metastatic liver disease is at the crossroads of an evolutionary transformation with more and more reports reiterating the benefits of resectional therapy in various cancers. A quest for application of laparoscopic approaches to the management of liver metastasis has arisen due to the projected benefits of less morbidity, early recovery, and equivalent oncological outcome in selected malignancies. However, the diverse and heterogenous data on indications, operative technique, and outcome evaluation make a comparative analysis of these studies difficult. This review is an appraisal of technique and outcome of minimally invasive liver resection as reported in the current literature with special reference to treatment of metastatic colorectal cancers.
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Affiliation(s)
- Priya Hazrah
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Deborshi Sharma
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India ; Type V/17, Block III, Lodhi Road Complex, New Delhi, 110003 India
| | - Saurabh Borgharia
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Pawan Kumar
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Romesh Lal
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
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13
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Ruiz A, Castro-Benitez C, Sebagh M, Giacchetti S, Castro-Santa E, Wicherts DA, van Hillegersberg R, Paule B, Castaing D, Morère JF, Adam R. Repeat Hepatectomy for Breast Cancer Liver Metastases. Ann Surg Oncol 2015; 22 Suppl 3:S1057-66. [PMID: 26259753 DOI: 10.1245/s10434-015-4785-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Resection of breast cancer liver metastases (BCLM) combined with systemic treatment is increasingly accepted as a therapeutic option; however, the potential benefit of repeat hepatectomy for recurrent BCLM is unknown. METHODS All consecutive female patients who underwent liver resection for BCLM at our center between January 1985 and December 2012 were included. Patients who had a single hepatectomy (N = 120) were compared with those who also underwent repeat hepatectomy (N = 19). Patients were selected for repeat hepatectomy based on operability and disease control. Prognostic factors of survival after repeat hepatectomy were determined. RESULTS Median overall survival since first hepatectomy was 35 months, with a 3- and 5-year survival rate of 50 and 38 %, respectively. Overall survival following repeat hepatectomy was 64 and 46 % at 3 and 5 years, respectively. From the time of first hepatectomy, patients who underwent repeat hepatectomy had a better survival than those who had only one hepatectomy (95 and 84 vs. 50 and 38 % at 3 and 5 years, respectively) (p = 0.002). Median survival was 35 and 100 months, respectively, and median survival since the diagnosis of BCLM was 51 and 112 months in the single and repeat hepatectomy groups, respectively. Since the time of diagnosis, overall 3-, 5-, and 7-year survival rates were 75, 57, and 44 %, respectively, for all 139 patients. Improved overall survival after repeat hepatectomy was related to a time interval between breast cancer diagnosis and first hepatectomy of >2 years, a limited hepatectomy, solitary liver metastasis, positive progesterone receptor status, and chemotherapy following repeat hepatectomy. Patients with single BCLM at first hepatectomy had a 3- and 5-year overall survival rate of 76 and 76 % compared with 51 and 17 % in patients with multiple metastases (p = 0.023). CONCLUSION In selected patients with BCLM, repeat hepatectomy for liver recurrence combined with systemic treatment provided survival rates comparable to those after first hepatectomy.
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Affiliation(s)
- Aldrick Ruiz
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlos Castro-Benitez
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Department of Surgery, Hospital Mexico, San Jose, Costa Rica
| | - Mylène Sebagh
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Sylvie Giacchetti
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Département de Cancérologie, APHP, Hopital Saint Louis, Paris, France
| | - Edward Castro-Santa
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,National Center for Transplantation and Hepato-Panacreato-Biliary Surgery of Costa Rica, San Jose, Costa Rica
| | - Dennis A Wicherts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bernard Paule
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.,Inserm, Université Paris-Sud, UMR-S 785, Villejuif, France
| | | | - René Adam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. .,Inserm, Université Paris-Sud, UMR-S 776, Villejuif, France.
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14
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Vertriest C, Berardi G, Tomassini F, Vanden Broucke R, Depypere H, Cocquyt V, Denys H, Van Belle S, Troisi RI. Resection of single metachronous liver metastases from breast cancer stage I-II yield excellent overall and disease-free survival. Single center experience and review of the literature. Dig Surg 2015; 32:52-9. [PMID: 25675843 DOI: 10.1159/000375132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/07/2015] [Indexed: 12/10/2022]
Abstract
PURPOSE Improved survival after liver resection for breast cancer liver metastases (BCLM) has been proven; however, there is still controversy on predictive factors influencing outcomes. The analysis of factors related to primary and metastatic cancer eventually influencing long-term outcomes and a review of the literature are presented in this report. METHODS Twenty-seven patients diagnosed with metachronous BCLM between 1996 and 2013 were retrospectively reviewed. Patients who had a minimum disease-free interval between primary tumor and liver metastasis of 12 months, no more than 3 liver lesions, no macroscopic extra-hepatic disease and in which systemic therapy showed a good response were included. RESULTS Twenty-two patients (82%) were initially diagnosed with a stage I-II disease. Twelve patients presented with multiple liver metastases. The 5 years overall survival (OS) rate was 78%, while the 5 years disease-free survival (DFS) rate was 36%. Initial tumor stage III-IV at first diagnosis and number of metastases >1 was significantly associated with a shorter DFS at multivariate analysis (p = 0.03 and p = 0.04 respectively). Patients with multiple lesions had a median DFS of 15 months compared to 47 months in patients with a single lesion (p = 0.03). CONCLUSIONS Resection of single BCLM from primary stage I-II cancer offers very good long-term survival rates and a low morbidity.
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Affiliation(s)
- Céline Vertriest
- Department of Obstetrics and Gynecology, Ghent University Hospital and Medical School, Ghent, Belgium
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15
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Zhang W, Yu H, Guo Z, Li B, Si T, Yang X, Wang H. Percutaneous cryoablation of liver metastases from breast cancer: initial experience in 17 patients. Clin Radiol 2013; 69:231-8. [PMID: 24238876 DOI: 10.1016/j.crad.2013.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/19/2013] [Accepted: 09/10/2013] [Indexed: 12/25/2022]
Abstract
AIM To assess the feasibility, safety, and effectiveness of percutaneous cryoablation for the treatment of liver metastases from breast cancer. MATERIALS AND METHODS This study included 39 liver metastases in 17 female breast cancer patients who underwent computed tomography (CT)-guided percutaneous cryoablation. The mean age of the cohort was 55 years (range 30-66 years). The tumour response was evaluated by CT performed before treatment, 1 month after treatment, and every 3 months thereafter. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) was used to assess the patients' quality of life before, 1 week, 1 month, and 3 months after cryoablation. The primary endpoints were technique effectiveness, quality of life, and complications. RESULTS The technical success rate was 92% with no major complication reported. At the 1-month follow-up, the primary technique effectiveness was 87.1% (34 of 39 tumours). At the 3-months follow-up, local tumour progression was observed in six of 39 lesions (15.4%). The 1-year survival from the time of cryoablation was 70.6%. The quality of life symptoms and functioning scales were preserved in patients alive at 3 months after cryoablation. The global quality of life, mean value of "pain" and "fatigue" between 3 months after cryoablation and prior to treatment showed statistically significant differences, but no clinical significance. CONCLUSIONS Cryoablation is a safe and effective ablative therapy, providing a high rate of local tumour control in breast cancer liver metastases.
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Affiliation(s)
- W Zhang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - H Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Z Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China.
| | - B Li
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - T Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - X Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - H Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
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16
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Cardi M, Sammartino P, Framarino ML, Biacchi D, Cortesi E, Sibio S, Accarpio F, Luciani C, Palazzo A, di Giorgio A. Treatment of peritoneal carcinomatosis from breast cancer by maximal cytoreduction and HIPEC: a preliminary report on 5 cases. Breast 2013; 22:845-9. [PMID: 23523180 DOI: 10.1016/j.breast.2013.02.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 02/19/2013] [Accepted: 02/27/2013] [Indexed: 12/31/2022] Open
Abstract
Although peritoneal carcinomatosis from breast cancer is a rare event it frequently causes morbidity and mortality. Current literature provides scarce information on its management. We report outcomes in 5 patients (mean age 59.4 years) with peritoneal carcinomatosis from breast cancer treated with maximal cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) by the closed technique, at 40 °C for 1 h with cisplatin 75 mg/m(2). The primary breast cancer was a ductal carcinoma in 3 patients and a lobular carcinoma in 2. Mean peritoneal cancer index was 20.2. In 4 of the 5 patients surgery achieved macroscopic complete cytoreduction. One patient died of disease at 56 months, 4 are alive and disease-free at 13, 45, 74 and 128 months. These encouraging outcomes suggest that cytoreduction and HIPEC is a promising approach to offer to highly selected patients with peritoneal carcinomatosis from breast cancer and that this approach merit investigation in a larger series.
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Affiliation(s)
- Maurizio Cardi
- Dipartimento di Chirurgia "P. Valdoni", Università di Roma "Sapienza", Azienda Policlinico Umberto I°, Viale del Policlinico 161, 00155 Rome, Italy.
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17
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Aggressive Treatment for Hepatic Metastases from Breast Cancer: Results from a Single Center. World J Surg 2013; 37:1322-32. [DOI: 10.1007/s00268-013-1986-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Collettini F, Golenia M, Schnapauff D, Poellinger A, Denecke T, Wust P, Riess H, Hamm B, Gebauer B. Percutaneous computed tomography-guided high-dose-rate brachytherapy ablation of breast cancer liver metastases: initial experience with 80 lesions. J Vasc Interv Radiol 2012; 23:618-26. [PMID: 22525020 DOI: 10.1016/j.jvir.2012.01.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To analyze initial experience with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM). MATERIALS AND METHODS Between January 2008 and December 2010, 37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34-83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid-enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter. RESULTS Two patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3-32 mo). Mean tumor diameter was 25.5 mm (range 8-74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3-39 months (median 18 months). CONCLUSIONS CT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM.
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Affiliation(s)
- Federico Collettini
- Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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19
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Chua TC, Saxena A, Liauw W, Chu F, Morris DL. Hepatic resection for metastatic breast cancer: a systematic review. Eur J Cancer 2011; 47:2282-90. [PMID: 21741832 DOI: 10.1016/j.ejca.2011.06.024] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 06/07/2011] [Accepted: 06/07/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Systemic chemotherapy is the mainstay of treatment for metastatic breast cancer with the role of surgery being strictly limited for palliation of metastatic complications or locoregional relapse. An increasing number of studies examining the role of therapeutic hepatic metastasectomy show encouraging survival results. A systematic review was undertaken to define its safety, efficacy and to identify prognostic factors associated with survival. METHODS Electronic search of the MEDLINE and PubMed databases (January 2000-January 2011) to identify studies reporting outcomes of hepatectomy for breast cancer liver metastases (BCLM) with hepatectomy was undertaken. Two reviewers independently appraised each study using a predetermined protocol. Safety and clinical efficacy was synthesised through a narrative review with full tabulation of results of all included studies. RESULTS Nineteen studies were examined. This comprised of 553 patients. Hepatectomy for BCLM was performed at a rate of 1.8 (range, 0.7-7.7) cases per year in reported series. The median time to liver metastases occurred at a median of 40 (range, 23-77) months. The median mortality and complication rate were 0% (range, 0-6%) and 21% (range, 0-44%), respectively. The median overall survival was 40 (range, 15-74) months and median 5-year survival rate was 40% (range, 21-80%). Potential prognostic factors associated with a poorer overall survival include a positive liver surgical margin and hormone refractory disease. CONCLUSION Hepatectomy is rarely performed for BCLM but the studies described in this review indicate consistent results with superior 5-year survival for selected patients with isolated liver metastases and in those with well controlled minimal extrahepatic disease. To evaluate its efficacy and control for selection bias, a randomised trial of standard chemotherapy with or without hepatectomy for BCLM is warranted.
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Affiliation(s)
- Terence C Chua
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St. George Hospital, Sydney, Australia
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