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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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Chen PC, Lee YC, Su YC, Lee CH, Chen JH, Chen CY. Does hepatectomy improve outcomes of breast cancer with liver metastasis? A nationwide analysis of real-world data in Taiwan. PLoS One 2022; 17:e0266960. [PMID: 35446891 PMCID: PMC9022801 DOI: 10.1371/journal.pone.0266960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Liver metastases from breast cancer are associated with poor prognosis, and treatment options are usually restricted to palliative systemic therapy. The impact of liver resection on metastasis remains controversial. The aim of this study is to investigate whether liver resection can offer better survival outcomes in cases of isolated liver metastases from breast cancer. Methods We conducted a nationwide cohort study using a claims dataset from Taiwan’s National Health Insurance Research Database (NHIRD). We identified all patients with breast cancer (diagnostic code ICD-9: 174.x) from the Registry for Catastrophic Illness Patient Database (RCIPD) of the NHIRD who underwent mastectomy between January 1, 2000, and December 31, 2008. Patients with other malignancies (history, initially, or during follow-up), those with a history of metastasis prior to or at initial admission for mastectomy, and those without liver metastases were excluded. Patients with other metastases between mastectomy and liver metastasis and those who died at first admission for liver resection were also excluded. All patients were followed up until December 31, 2013, or withdraw from the database because of death. Results Data were analyzed for 1,116 patients who fulfilled the inclusion criteria (resection group: 89; non-resection group: 1,027). There were no differences in age, Charlson Comorbidity Index, or major coexisting diseases except renal disease between two groups. Kaplan–Meier analysis demonstrated that the liver resection group had significantly better overall survival (OS) than the non-resection group. (1-year: 96.6% vs. 52.3%, 2-year: 86.8% vs. 35.4%, 3-year: 72.3% vs. 25.2%, 5-year: 51.6% vs. 16.9%, respectively, p<0.001). Cox analysis revealed that the liver resection group exhibited a significant improvement in patient survival (hazard ratio [HR] = 0.321, 95% confidence interval [CI]: 0.234–0.440, p<0.001). Conclusion These findings indicate that liver resection may offer better survival benefit in patients with breast cancer who develop new liver metastases post mastectomy.
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Affiliation(s)
- Pin-Chun Chen
- Division of Colon & Rectal Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
- Division of General Surgery, E-Da Da-Chang Hospital, Kaohsiung, Taiwan
| | - Yuan-Chi Lee
- Division of General Surgery, E-Da Da-Chang Hospital, Kaohsiung, Taiwan
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Chieh Su
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Hematology-Oncology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheng-Hung Lee
- Department of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jian-Han Chen
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- * E-mail:
| | - Chung-Yen Chen
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
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Rivera K, Jeyarajah DR, Washington K. Hepatectomy, RFA, and Other Liver Directed Therapies for Treatment of Breast Cancer Liver Metastasis: A Systematic Review. Front Oncol 2021; 11:643383. [PMID: 33842354 PMCID: PMC8033007 DOI: 10.3389/fonc.2021.643383] [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] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/22/2023] Open
Abstract
Background The liver is the second most common site of breast cancer metastasis. Liver directed therapies including hepatic resection, radiofrequency ablation (RFA), transarterial chemo- and radioembolization (TACE/TARE), and hepatic arterial infusion (HAI) have been scarcely researched for breast cancer liver metastasis (BCLM). The purpose of this review is to present the known body of literature on these therapies for BCLM. Methods A systematic review was performed with pre-specified search terms using PubMed, MEDLINE, EMBASE, and Cochrane Review resulting in 9,957 results. After review of abstracts and application of exclusion criteria, 51 studies were included in this review. Results Hepatic resection afforded the longest median overall survival (mOS) and 5-year survival (45 mo, 41%) across 23 studies. RFA was presented in six studies with pooled mOS and 5-year survival of 38 mo and 11–33%. Disease burden and tumor size was lower amongst hepatic resection and RFA patients. TACE was presented in eight studies with pooled mOS and 1-year survival of 19.6 mo and 32–88.8%. TARE was presented in 10 studies with pooled mOS and 1-year survival of 11.5 mo and 34.5–86%. TACE and TARE populations were selected for chemo-resistant, unresectable disease. Hepatic arterial infusion was presented in five studies with pooled mOS of 11.3 months. Conclusion Although further studies are necessary to delineate appropriate usage of liver directed therapies in BCLM, small studies suggest hepatic resection and RFA, in well selected patients, can result in prolonged survival. Longitudinal studies with larger cohorts are warranted to further investigate the effectiveness of each modality.
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Affiliation(s)
- Kevin Rivera
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Dhiresh Rohan Jeyarajah
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Kimberly Washington
- School of Medicine, Texas Christian University/University of North Texas Health Sciences Center, Fort Worth, TX, United States
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Orlandi A, Pontolillo L, Mele C, Pasqualoni M, Pannunzio S, Cannizzaro MC, Cutigni C, Palazzo A, Garufi G, Vellone M, Ardito F, Franceschini G, Sanchez AM, Cassano A, Giuliante F, Bria E, Tortora G. Liver Metastasectomy for Metastatic Breast Cancer Patients: A Single Institution Retrospective Analysis. J Pers Med 2021; 11:jpm11030187. [PMID: 33800160 PMCID: PMC7998479 DOI: 10.3390/jpm11030187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022] Open
Abstract
The liver represents the first metastatic site in 5–12% of metastatic breast cancer (MBC) cases. In absence of reliable evidence, liver metastasectomy (LM) could represent a possible therapeutic option for selected MBC patients (patients) in clinical practice. A retrospective analysis including MBC patients who had undergone an LM after a multidisciplinary Tumor Board discussion at the Hepatobiliary Surgery Unit of Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS in Rome, between January 1994 and December 2019 was conducted. The primary endpoint was overall survival (OS) after a MBC-LM; the secondary endpoint was the disease-free interval (DFI) after surgery. Forty-nine MBC patients underwent LM, but clinical data were only available for 22 patients. After a median follow-up of 71 months, median OS and DFI were 67 months (95% CI 45–103) and 15 months (95% CI 11–46), respectively. At univariate analysis, the presence of a negative resection margin (R0) was the only factor that statistically significantly influenced OS (78 months versus 16 months; HR 0.083, p < 0.0001) and DFI (16 months versus 5 months; HR 0.17, p = 0.0058). A LM for MBC might represent a therapeutic option for selected patients. The radical nature of the surgical procedure performed in a high-flow center and after a multidisciplinary discussion appears essential for this therapeutic option.
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Affiliation(s)
- Armando Orlandi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Correspondence: ; Tel.: +39-0630-156-318
| | - Letizia Pontolillo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Caterina Mele
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Mariangela Pasqualoni
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Sergio Pannunzio
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Maria Chiara Cannizzaro
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Claudia Cutigni
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Antonella Palazzo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
| | - Giovanna Garufi
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Maria Vellone
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Ardito
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Gianluca Franceschini
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Alessandra Cassano
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Felice Giuliante
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
- Comprehensive Cancer Center, Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Emilio Bria
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
| | - Giampaolo Tortora
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.P.); (M.P.); (S.P.); (M.C.C.); (C.C.); (A.P.); (G.G.); (A.C.); (E.B.); (G.T.)
- Catholic University of Sacred Heart, 00168 Rome, Italy; (M.V.); (F.A.); (G.F.); (F.G.)
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van Ommen-Nijhof A, Steenbruggen TG, Schats W, Wiersma T, Horlings HM, Mann R, Koppert L, van Werkhoven E, Sonke GS, Jager A. Prognostic factors in patients with oligometastatic breast cancer - A systematic review. Cancer Treat Rev 2020; 91:102114. [PMID: 33161237 DOI: 10.1016/j.ctrv.2020.102114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
AIM Oligometastatic breast cancer (OMBC) is a disease-entity with potential for long-term remission in selected patients. Those with truly limited metastatic load (rather than occult widespread metastatic disease) may benefit from multimodality treatment including local ablative therapy of distant metastases. In this systematic review, we studied factors associated with long-term survival in patients with OMBC. METHODS Eligible studies included patients with OMBC who received a combination of local and systemic therapy as multimodal approach and reported overall survival (OS) or progression-free survival (PFS), or both. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of each included study. Independent prognostic factors for OS and/or PFS are summarized. RESULTS Of 1271 screened abstracts, 317 papers were full-text screened and twenty studies were included. Eleven of twenty studies were classified as acceptable quality. Definition of OMBC varied between studies and mostly incorporated the number and/or location of metastases. The 5-year OS ranged between 30 and 79% and 5-year PFS ranged between 25 and 57%. Twelve studies evaluated prognostic factors for OS and/or PFS in multivariable models. A solitary metastasis, >24 months interval between primary tumor and OMBC, no or limited involved axillary lymph nodes at primary diagnosis, and hormone-receptor positivity were associated with better outcome. HER2-positivity was associated with worse outcome, but only few patients received anti-HER2 therapy. CONCLUSIONS OMBC patients with a solitary distant metastasis and >24 months disease-free interval have the best OS and may be optimal candidates to consider a multidisciplinary approach.
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Affiliation(s)
- Annemiek van Ommen-Nijhof
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands.
| | - Tessa G Steenbruggen
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Winnie Schats
- Department of Scientific Information Service, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Terry Wiersma
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Hugo M Horlings
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Ritse Mann
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Linetta Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, PO Box 2060, 3000 CB Rotterdam, the Netherlands
| | - Erik van Werkhoven
- Department of Biostatistics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 2060, 3000 CB Rotterdam, the Netherlands
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Terata K, Imai K, Wakita A, Sato Y, Motoyama S, Minamiya Y. Surgical therapy for breast cancer liver metastases. Transl Cancer Res 2020; 9:5053-5062. [PMID: 35117871 PMCID: PMC8797688 DOI: 10.21037/tcr-20-1598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer in females worldwide. If diagnosed early, patients generally have good outcomes. However, approximately 20% to 30% of all women diagnosed with breast cancer develop metastatic disease. Metastatic breast cancer is incurable, but there is growing evidence that resection or other local therapy for breast cancer liver metastases (BCLM) may improve survival. We aimed to review indications for and outcomes of perioperative liver resection and other local therapies for BCLM. In this series, we reviewed 11 articles (605 patients) focusing on surgical resection and 7 articles (266 patients) describing radiofrequency ablation (RFA) for BCLM. Median disease-free survival (DFS) after surgical resection was 23 months (range, 14–29 months) and median overall survival (OS) was 39.5 months (range, 26–82 months). One, 3- and 5-year survivals were 89.5%, 70%, and 38%, respectively. The factors favoring better outcomes are hormone receptor positive primary breast cancer status, R0 resection, no extrahepatic metastases (EHM), small BCLM, and solitary liver metastases. On the other hand, the median DFS with RFA was 11 months, median OS was 32 months, and the 3- and 5-year OS were 43% and 27%, respectively. The clinical features that are indications for RFA are smaller tumor and higher EHM rate than those favoring surgical resection (2.4 vs. 4.0 cm and 46% vs. 27%). The merits of RFA are its high technical success rate, low morbidity, short hospital stay, and that it can be repeated. Although results are as yet limited, in carefully selected patients, resection or other local therapies such as RFA, render BCLM potentially provide prognostic improvement.
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Affiliation(s)
- Kaori Terata
- Department of Breast and Endocrine Surgery, Akita University Hospital, Akita, Japan.,Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Comparison of hepatic resection and systemic treatment of breast cancer liver metastases: A propensity score matching study. Am J Surg 2020; 220:945-951. [PMID: 32145919 DOI: 10.1016/j.amjsurg.2020.02.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of surgery in breast cancer liver metastases (BCLM) remains elusive, and current application is limited. Our aim is to investigate whether hepatic resection (HR) of BCLM improves survival compared with non-hepatic resection (NHR) treatment. METHODS Three hundred and eighty-four patients with BCLM from 2008 to 2018 were divided into two groups. Propensity score matching (PSM) analysis was used to compare the clinical outcomes. RESULTS After PSM the mean overall survival (OS) and the 1, 3, and 5-year OS rates in HR group were 61.8 months, 92.6%, 54.7% and 54.7%, respectively; while for NHR group these values were 38.6 months, 79.2%, 45.6% and 21.9%, respectively (p < 0.007). Multivariate analysis indicated hormonal receptor status (p = 0.039) and hepatic resection (p = 0.032) were independent prognostic factors. CONCLUSION Our study revealed that hepatectomy yields a survival benefit safely compared with medical treatments, especially for patients with positive hormonal receptors.
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Surgical treatment of breast cancer liver metastases - A nationwide registry-based case control study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1006-1012. [PMID: 32098734 DOI: 10.1016/j.ejso.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/27/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The benefit of liver resection or ablation for breast cancer liver metastases (BCLM) remains unclear. The aim of the study was to determine survival after isolated BCLM in nationwide cohorts and compare surgical versus systemic treatment regimens. MATERIALS AND METHODS The Swedish register for cancer in the liver and the bile ducts (SweLiv) and the National register for breast cancer (NBCR) was studied to identify patients with 1-5 BCLM without extrahepatic spread diagnosed 2009-2016. Data from the registers were validated and completed by review of medical records. A Kaplan-Meier plot and log rank test were used to analyse survival. Prognostic and predictive factors were evaluated by Cox regression analysis. RESULTS A surgical cohort (n = 29) was identified and compared to a control cohort (n = 33) receiving systemic treatment only. There was no 90-day mortality after surgery. Median survival from BCLM diagnosis was 77 months (95% CI 41-113) in the surgical cohort and 28 months (95% CI 13-43) in the control cohort, (p = 0.004). There was a longer disease-free interval and more oestrogen receptor positive tumours in the surgical cohort. Surgery was a significant positive predictive factor in univariate analysis while a multivariable analysis resulted in HR 0.478 (CI 0.193-1.181, p = 0.110) for surgical treatment. CONCLUSION Surgery for BCLM is safe and might provide a survival benefit in selected patients but prospective trials are warranted to avoid selection bias.
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Lucidi V, Bohlok A, Liberale G, Bez M, Germanova D, Bouazza F, Demetter P, Larsimont D, Aftimos P, Smoll NR, Donckier V. Extended time interval between diagnosis and surgery does not improve the outcome in patients operated for resection or ablation of breast cancer liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 46:229-234. [PMID: 31677938 DOI: 10.1016/j.ejso.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/30/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast cancer liver metastases (BCLM) is considered a systemic disease with poorly defined selection criteria for surgery and little evidence for the appropriate timing of surgery. METHODS Postoperative outcomes of patients operated for BCLM were retrospectively reviewed and compared based on the timing of surgery, with the early surgery (ES) group treated ≤12 months after BCLM diagnosis, and late surgery (LS) group operated >12 months after diagnosis. RESULTS Seventy-two patients with BCLM underwent liver surgery, including 37 and 35 in the ES and LS groups, respectively. Demographic and preoperative characteristics were similar between the groups, except that multifocal liver disease was more frequent in the LS group (p = 0.008). The LS group had a morbidity rate of 38%, compared to 11% in the ES group (p = 0.015). No postoperative deaths occurred. In the whole cohort, median progression-free (PFS) and overall survival (OS) were 19 and 50 months, respectively, and 1-, 3- and 5-year PFS and OS were 63%, 41%, 24% and 93%, 66%, 43%, respectively, with no significant difference observed between the ES and LS groups. Multivariate analysis revealed that breast cancer progesterone receptor negativity (HR = 3.34, p = 0.03) and a size of LM > 40 mm (HR = 3.11, p = 0.01) were significant negative prognostic factors for PFS. Only a size of LM > 40 mm (HR = 2.79, p = 0.008) was significantly associated with shorter OS. CONCLUSION A prolonged preoperative observational period does not improve long-term outcomes after liver surgery in patients with resectable BCLM, suggesting that early management can safely be proposed to those patients, with good oncological outcomes.
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Affiliation(s)
- Valerio Lucidi
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, Université Libre de Bruxelles, 1070, Brussels, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Ali Bohlok
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Mattia Bez
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Desislava Germanova
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, Université Libre de Bruxelles, 1070, Brussels, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Fikri Bouazza
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Pieter Demetter
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, 1070, Brussels, Belgium; Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium.
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium.
| | - Philippe Aftimos
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium.
| | - Nicolas Roydon Smoll
- School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Vincent Donckier
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000, Brussels, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Université Libre de Bruxelles, 1070, Brussels, Belgium.
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10
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Bale R, Putzer D, Schullian P. Local Treatment of Breast Cancer Liver Metastasis. Cancers (Basel) 2019; 11:cancers11091341. [PMID: 31514362 PMCID: PMC6770644 DOI: 10.3390/cancers11091341] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022] Open
Abstract
Breast cancer represents a leading cause of death worldwide. Despite the advances in systemic therapies, the prognosis for patients with breast cancer liver metastasis (BCLM) remains poor. Especially in case of failure or cessation of systemic treatments, surgical resection for BCLMs has been considered as the treatment standard despite a lack of robust evidence of benefit. However, due to the extent and location of disease and physical condition, the number of patients with BCLM who are eligible for surgery is limited. Palliative locoregional treatments of liver metastases (LM) include transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Percutaneous thermal ablation methods, such as radiofrequency ablation (RFA) and microwave ablation (MWA), are considered potentially curative local treatment options. They are less invasive, less expensive and have fewer contraindications and complication rates than surgery. Because conventional ultrasound- and computed tomography-guided single-probe thermal ablation is limited by tumor size, multi-probe stereotactic radiofrequency ablation (SRFA) with intraoperative image fusion for immediate, reliable judgment has been developed in order to treat large and multiple tumors within one session. This review focuses on the different minimally invasive local and locoregional treatment options for BCLM and attempts to describe their current and future role in the multidisciplinary treatment setting.
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Affiliation(s)
- Reto Bale
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy, Medical University of Innsbruck, 6020 Innsbruck, Austria.
| | - Peter Schullian
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy, Medical University of Innsbruck, 6020 Innsbruck, Austria.
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11
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He X, Zhang Q, Feng Y, Li Z, Pan Q, Zhao Y, Zhu W, Zhang N, Zhou J, Wang L, Wang M, Liu Z, Zhu H, Shao Z, Wang L. Resection of liver metastases from breast cancer: a multicentre analysis. Clin Transl Oncol 2019; 22:512-521. [PMID: 31230220 DOI: 10.1007/s12094-019-02155-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery is becoming more practical and effective than conservative treatment in improving the poor outcomes of patients with breast cancer liver metastasis (BCLM). However, there is no generally acknowledged set of standards for identifying BCLM candidates who will benefit from surgery. METHODS Between January 2011 and September 2018, 67 female BCLM patients who underwent partial hepatectomy were selected for analysis in the present study. Prognostic factors after hepatectomy were determined. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and intrahepatic recurrence-free survival (IHRFS). RESULTS The 1-, 3- and 5-year OS of patients treated with surgery was 93.5%, 73.7% and 32.2%, respectively, with a median survival time of 57.59 months. The Pringle manoeuvre [hazard radio (HR) = 0.117, 95% CI0.015-0.942, p = 0.044] and an increased interval between breast surgery and BCLM diagnosis (HR0.178, 95% CI 0.037-0.869, p = 0.033) independently predicted improved overall survival for BCLM patients. The 1-, 2- and 3-year IHRFS of patients who underwent surgery was 62.8, 32.6% and 10.9%, respectively, with a median intrahepatic recurrence-free survival time of 13.47 months. Moderately differentiated tumours (HR 0.259, 95% CI 0.078-0.857, p = 0.027) and the development of liver metastasis more than 2 years after breast surgery (HR 0.270, 95% CI 0.108-0.675, p = 0.005) might be predictors of increased IHRFS. CONCLUSIONS An interval of more than 2 years between breast cancer surgery and liver metastasis seems to be an indication of liver surgery in BCLM patients. The Pringle manoeuvre and moderately differentiated tumours are potential predictors associated with OS and IHRFS, respectively, as benefits from liver resection. Studies with increased sample sizes are warranted to validate our results.
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Affiliation(s)
- X He
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Q Zhang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Y Feng
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Z Li
- Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China
| | - Q Pan
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Y Zhao
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - W Zhu
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - N Zhang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - J Zhou
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - L Wang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - M Wang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Z Liu
- Department of General Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, 250012, China
| | - H Zhu
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Z Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - L Wang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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12
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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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13
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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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14
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Tasleem S, Bolger JC, Kelly ME, Boland MR, Bowden D, Sweeney KJ, Malone C. The role of liver resection in patients with metastatic breast cancer: a systematic review examining the survival impact. Ir J Med Sci 2018; 187:1009-1020. [PMID: 29392651 DOI: 10.1007/s11845-018-1746-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/11/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Approximately 10% of breast cancer patients will present with solid organ metastases, while up to 30% will develop metastatic disease during their treatment course. Liver metastases are usually treated with systemic chemotherapy. Although colorectal liver metastases are routinely resected, this is not yet the standard of care for breast cancer-related liver metastases. This review examines the evidence for resection of breast cancer-related liver metastases. METHODS A systematic review identified 25 articles for inclusion, 12 papers concerning patients with isolated liver metastases, and 13 papers concerning patients with extrahepatic metastases. Data from 1080 patients were included. RESULTS Two hundred eighty patients underwent hepatic resections for breast cancer-associated metastases with no extrahepatic metastases. Reported 5-year survival ranged from 24.6 to 78%. Median overall survival ranged from 29.5 to 116 months. For patients with oligometastatic disease undergoing resection, 5-year survival ranged from 21 to 57%, with median overall survival ranging from 32 to 58 months. Reported 30-day morbidity ranged from 14 to 42% for isolated and multiple metastases. CONCLUSION Hepatic resection can be considered in the management of breast cancer patients with isolated liver metastases as well as those with oligometastatic disease.
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Affiliation(s)
- Sadia Tasleem
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland
| | - Jarlath C Bolger
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland.
| | - Michael E Kelly
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland
| | - Michael R Boland
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland
| | - Dermot Bowden
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland
| | - Karl J Sweeney
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland
| | - Carmel Malone
- Department of Breast Surgery, University Hospital Galway, Saolta University Hospital Group, Galway, Ireland
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15
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Ercolani G, Zanello M, Serenari M, Cescon M, Cucchetti A, Ravaioli M, Del Gaudio M, D'Errico A, Brandi G, Pinna AD. Ten-Year Survival after Liver Resection for Breast Metastases: A Single-Center Experience. Dig Surg 2018; 35:372-380. [PMID: 29393171 DOI: 10.1159/000486523] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of liver resection for metastatic breast carcinoma is still debated. METHODS Fifty-one resected patients were reviewed. All patients received adjuvant chemotherapy after resection of the primary tumor. Clinicopathological characteristics and immunohistochemistry expression of estrogen (ER), progesterone (PR), human epidermal growth factor (HER2), or Ki67 were evaluated. RESULTS The median number of metastases was 2; single metastases were present in 24 (47%) patients. The median tumor diameter was 4 cm. Major hepatectomies were performed in 31 (61%) patients. Postoperative mortality was null. Postoperative morbidity was 13.7%. The 1-, 5-, and 10-year survival rates were 92, 36, and 16% respectively. Eleven (21.6%) patients survived longer than 5 years and 8.9% are alive without recurrence 10 years after surgery. At the univariate analysis, tumor diameter, lymph node status, PR receptor status, and triple positive receptors (ER+/PR+/Her2+) were significantly related to survival. At the multivariate analysis, tumor diameter, PR receptor, and triple negative status were significantly related to the long-term outcome. CONCLUSION Liver resection seems to be a safe and effective treatment for metastases from breast cancer, and encouraging long-term survival can be obtained with acceptable risk in selected patients. Tumors less than 5 cm and positive hormone receptor status are the best prognostic factors.
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Affiliation(s)
- Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Metteo Zanello
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Matteo Serenari
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Matteo Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Massimo Del Gaudio
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Antonietta D'Errico
- Department on Oncology and Pathology, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Giovanni Brandi
- Department on Oncology and Pathology, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Antonio Daniele Pinna
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola Hospital, Bologna, Italy
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16
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Bale R, Richter M, Dünser M, Levy E, Buchberger W, Schullian P. Stereotactic Radiofrequency Ablation for Breast Cancer Liver Metastases. J Vasc Interv Radiol 2017; 29:262-267. [PMID: 29273283 DOI: 10.1016/j.jvir.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate outcomes in patients with liver metastases from breast cancer treated with stereotactic radiofrequency (RF) ablation. MATERIALS AND METHODS A retrospective analysis of 29 stereotactic RF ablation treatment sessions in 26 consecutive patients with 64 biopsy-proven breast cancer liver metastases (BCLMs) was conducted. Patients were included only if systemic treatment failed and all visible BCLMs were treatable. RESULTS Primary and secondary technical success rates were 96.9% (62 of 64) and 100%, respectively. There were no perioperative mortalities. Local recurrence was identified in 5 tumors (7.8%), with no significant differences among tumor sizes (P = .662): < 3 cm (9.3%), 3-5 cm (0%), and > 5 cm (8.3%). Median estimated overall survival (OS) from first stereotactic ablation treatment was 29.3 months ± 8.9 (95% confidence interval [CI], 11.9-46.8 mo; mean, 28.7 mo) after a median follow-up of 23.1 months (mean, 31.3 mo; range, 0.1-100.8 mo). No significant differences in OS (P = .223) were observed among tumor volumes < 50 cm3 (median, 84.9 mo ± 53.1; mean, 58.4 mo), 50-100 cm3 (median, 37.8 mo ± 5.7; mean, 36.3 mo), and > 100 cm3 (median, 17.1 mo ± 3.5; mean, 21.8 mo). Numbers of metastases did not affect estimated OS, with a median OS of 32.7 months ± 10.4 (mean, 35.8 mo) for single lesions vs 17.7 months ± 3.2 (mean, 25.9 mo) for 2/3 lesions and a mean of 68.4 months ± 17.23 for > 3 lesions (P = .113). CONCLUSIONS Multiple-electrode stereotactic RF ablation proved to be a safe minimally invasive alternative to surgical liver resection in selected patients with BCLMs.
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Affiliation(s)
- Reto Bale
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Michael Richter
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Martina Dünser
- Department of Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Elliot Levy
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Wolfgang Buchberger
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Section of Microinvasive Therapy, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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17
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Golse N, Adam R. Liver Metastases From Breast Cancer: What Role for Surgery? Indications and Results. Clin Breast Cancer 2017; 17:256-265. [DOI: 10.1016/j.clbc.2016.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
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18
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Hepatic arterial infusion chemotherapy for extensive liver metastases of breast cancer: efficacy, safety and prognostic parameters. J Cancer Res Clin Oncol 2017. [PMID: 28646261 DOI: 10.1007/s00432-017-2462-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Hepatic arterial infusion chemotherapy (HAIC) is an option for patients with liver-predominant metastatic breast cancer (LMBC), when no further systemic treatment is available. But systematic reports are limited. Here we conducted a retrospective analysis of LMBC patients treated at an expert center. METHODS Individual patient data were retrieved from the clinical data base of the West German Cancer Center. Primary endpoints included hepatic response (RECIST), progression-free survival (PFS), overall survival (OS), and toxicity. A score based on LDH, AST, ALT and bilirubine was developed to estimate the hepatic metastasis load. RESULTS Data from 70 consecutive patients were included. All patients were heavily pretreated (median 7 treatment lines for LMBC). HAIC protocols included mitomycin/5-FU (70%), mitomycin (14.3%), melphalan (12.9%) and 5-FU (7.1%), with selection based on patient characteristics. Partial hepatic remission was obtained as best response in 14 patients (20.0%), stable disease in 27 patients (38.6%), and progressive disease in 29 patients (41.4%). Median PFS and OS from initiation of HAIC were 2 (range 0-10) and 7 months (range 1-37). Mainly hepatic and hematopoietic HAIC-related toxicities were observed; there was no treatment-related death. The hepatic metastasis score effectively separated two prognostic groups: Patients with a score <3 had significantly superior PFS (15 vs 7 weeks, p = 0.017) and OS (12 vs 5 months, p = 0.002). CONCLUSION HAIC offers a safe and effective salvage treatment strategy in heavily pretreated patients with LMBC and no further treatment options. The hepatic metastasis score may help to identify patients with sustained clinical benefit.
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19
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白 秀, 杨 薇, 严 昆. 乳腺癌肝转移治疗现状及射频消融的应用及前景. Shijie Huaren Xiaohua Zazhi 2017; 25:1143-1149. [DOI: 10.11569/wcjd.v25.i13.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
乳腺癌是女性发病率和死亡率最高的恶性肿瘤. 乳腺癌晚期常发生转移, 好发转移部位依次为骨、肺、肝等. 近年来, 虽然乳腺癌肝转移(breast cancer liver metastases, BCLM)治疗成功率逐渐提高, 但是BCLM的预后仍然较差. 目前, BCLM的治疗方式尚未成熟, 主要以手术切除、化疗、射频消融(radiofrequency ablation, RFA)治疗、肝动脉栓塞灌注化疗等为主. 本文回顾分析了国内外有关治疗BCLM治疗的文献, 其中重点关注BCLM局部治疗中的RFA治疗, 分析RFA治疗BCLM的应用及前景.
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20
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Systematic review of early and long-term outcome of liver resection for metastatic breast cancer: Is there a survival benefit? Breast 2017; 32:162-172. [DOI: 10.1016/j.breast.2017.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/29/2016] [Accepted: 02/04/2017] [Indexed: 12/21/2022] Open
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21
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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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22
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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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23
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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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24
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Tanei T, Leonard F, Liu X, Alexander JF, Saito Y, Ferrari M, Godin B, Yokoi K. Redirecting Transport of Nanoparticle Albumin-Bound Paclitaxel to Macrophages Enhances Therapeutic Efficacy against Liver Metastases. Cancer Res 2016; 76:429-39. [PMID: 26744528 DOI: 10.1158/0008-5472.can-15-1576] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/21/2015] [Indexed: 11/16/2022]
Abstract
Current treatments for liver metastases arising from primary breast and lung cancers are minimally effective. One reason for this unfavorable outcome is that liver metastases are poorly vascularized, limiting the ability to deliver therapeutics from the systemic circulation to lesions. Seeking to enhance transport of agents into the tumor microenvironment, we designed a system in which nanoparticle albumin-bound paclitaxel (nAb-PTX) is loaded into a nanoporous solid multistage nanovector (MSV) to enable the passage of the drug through the tumor vessel wall and enhance its interaction with liver macrophages. MSV enablement increased nAb-PTX efficacy and survival in mouse models of breast and lung liver metastasis. MSV-nAb-PTX also augmented the accumulation of paclitaxel and MSV in the liver, specifically in macrophages, whereas paclitaxel levels in the blood were unchanged after administering MSV-nAb-PTX or nAb-PTX. In vitro studies demonstrated that macrophages treated with MSV-nAb-PTX remained viable and were able to internalize, retain, and release significantly higher quantities of paclitaxel compared with treatment with nAb-PTX. The cytotoxic potency of the released paclitaxel was also confirmed in tumor cells cultured with the supernatants of macrophage treated with MSV-nAB-PTX. Collectively, our findings showed how redirecting nAb-PTX to liver macrophages within the tumor microenvironment can elicit a greater therapeutic response in patients with metastatic liver cancer, without increasing systemic side effects.
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Affiliation(s)
- Tomonori Tanei
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Fransisca Leonard
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Xuewu Liu
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Jenolyn F Alexander
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Yuki Saito
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Mauro Ferrari
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas
| | - Biana Godin
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas.
| | - Kenji Yokoi
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas.
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25
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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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26
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Liver metastases from non-gastrointestinal non-neuroendocrine tumours: review of the literature. Updates Surg 2015; 67:223-33. [PMID: 26341625 DOI: 10.1007/s13304-015-0315-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/21/2015] [Indexed: 12/23/2022]
Abstract
Liver resection is integrated in the oncological surgical management of metastatic gastrointestinal and neuroendocrine tumours. However, the good prognosis reached in these cases has not been obtained for metastatic tumours of other histological types. In this review, we analysed the published case reports and series of hepatectomies in patients with metastatic breast cancer, melanoma, sarcoma, genitourinary tumours, pulmonary and adrenocortical tumours. From the reported data the surgical resection of oligometastases yields good results in terms of improved survival, in particular when the disease-free time period is longer than 1 year. Hepatic resection can be a valid surgical strategy to obtain a survival benefit in patients with liver metastases from non-gastrointestinal, non-neuroendocrine tumours. However, a careful patient selection is needed in order to obtain a real survival benefit; patients with a good performance status, with a disease-free period longer than 1 year and with oligometastases may obtain the best advantage from this approach.
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27
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Bacalbaşa N, Alexandrescu ST, Popescu I. A role for hepatic surgery in patients with liver metastatic breast cancer: review of literature. Hepat Oncol 2015; 2:159-170. [PMID: 30190995 PMCID: PMC6095411 DOI: 10.2217/hep.14.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Traditionally, patients with metastatic breast cancer were seen as carrying a grim prognosis and therapy was based mainly on palliative chemotherapy and hormonal therapy, with surgery being considered as ineffective. However, in the last 20 years different centers worldwide published series of metastatic breast cancer patients who underwent resection for different metastatic sites (liver, brain, lung), reporting favorable results. Most of these papers addressed to the role of liver surgery in patients with breast cancer liver metastases, mainly due to the favorable results achieved by liver resection in patients with metastatic colorectal cancer. In this review are presented the results achieved by liver surgery in patients with breast cancer liver metastases.
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Affiliation(s)
- Nicolae Bacalbaşa
- ‘Carol Davila’ University of Medicine & Pharmacy, Bucharest, Romania
| | - Sorin Tiberiu Alexandrescu
- ‘Carol Davila’ University of Medicine & Pharmacy, Bucharest, Romania
- Dan Setlacec Center of General Surgery & Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- ‘Carol Davila’ University of Medicine & Pharmacy, Bucharest, Romania
- Dan Setlacec Center of General Surgery & Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
- Center of Digestive Diseases & Liver Transplantation, Center of General Surgery & Liver, Transplantation ‘Dan Setlacec’, of Fundeni Clinical Institute, Bucharest, Romania, Sos. Fundeni 258, Bucharest 022328, Romania
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28
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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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29
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Mátrai Z, Rényi Vámos F. [Surgical possibilities in the treatment of advanced and locally recurrent breast cancers]. Orv Hetil 2014; 155:1461-8. [PMID: 25194868 DOI: 10.1556/oh.2014.29891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stage IV breast cancer is an incurable but treatable condition. Therapy of distant metastatic disease consists primarily of systemic and symptomatic treatments, while the role of surgery is subordinate. Conventional medical treatments result in 18-24 months average overall survival, and about 5-20% 5-year overall survival. However, it seems that in selected cases with solitary or oligometastases, mainly in those which respond well to drug therapy, the aggressive surgical removal of both the primary tumour and visceral metastases results in a survival advantage. After accurate evaluation of the patients, the indication for surgical treatment should be established through a biological and multidisciplinary approach. Other possible indications for surgical treatment are ulceration, bleeding, hygienic conditions undignified of human life, central nervous system metastases, acute neurological disorders, hydro- and pneumothorax greatly reducing respiratory surface and impending fractures. Surgical procedures include simple pleural drainage, minimal invasive techniques, large body cavity surgeries, extensive resection of soft tissue and chest wall due to the primary tumor, and plastic surgical reconstruction as well. Scientific assessment of the oncological value of surgical oncological interventions in stage IV. breast cancer require further multicentric prospective comparative studies. The present paper provides a broad review of the literature on surgical interventions and results in patients with breast cancer and remote metastases, and the surgical options of locally recurrent tumours.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet, Daganatsebészeti Központ Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1125
| | - Ferenc Rényi Vámos
- Országos Onkológiai Intézet, Daganatsebészeti Központ Mellkassebészeti Osztály Budapest
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30
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Seyal AR, Parekh K, Velichko YS, Salem R, Yaghmai V. Tumor growth kinetics versus RECIST to assess response to locoregional therapy in breast cancer liver metastases. Acad Radiol 2014; 21:950-7. [PMID: 24833565 DOI: 10.1016/j.acra.2014.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/15/2014] [Accepted: 02/25/2014] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of our study was to evaluate changes in growth kinetics of breast cancer liver metastasis in response to locoregional therapy and compare them to Response Evaluation Criteria in Solid Tumors (RECIST). MATERIALS AND METHODS This Health Insurance Portability and Accountability Act-compliant retrospective study was Institutional Review Board approved. Thirty-four chemorefractory breast cancer liver metastases from 21 patients treated with yttrium-90 ((90)Y) were evaluated. Pre- and posttreatment computed tomography (CT) scans were used to calculate tumor growth kinetics. The growth parameter analyzed was reciprocal of doubling time (RDT). RDT range for stable disease (SD) was defined by the measurement error rate. A negative RDT below the SD range defined response and was categorized as either partial response (PR) or complete response, whereas a positive RDT value above the SD range indicated progressive disease (PD). Comparison was made to tumor response classification according to percentage change in the lesion's maximal diameter per RECIST. Lin's concordance correlation coefficient, Bland-Altman plot, Wilcoxon signed rank test, and Student t test were used for analysis. Significance was set at 0.05. RESULTS RDT range for SD ranged from -0.46 to +2.17. Six lesions with PR based on RECIST showed PR based on their volumetric growth rate (mean RDT of -17.3 ± 2.6). Similarly, one lesion with PD according to RECIST was categorized as PD based on its growth kinetics (RDT of 10.2). However, 14 (51.85%) lesions classified as SD by RECIST had PR according to growth kinetics (mean RDT of -7.8), six (22.22%) lesions were categorized as SD (mean RDT of 0.8), whereas seven (25.93%) lesions showed PD (mean RDT of 4.5). Growth kinetic parameters were significantly different for lesions with PR when compared to lesions with PD (P < .0001). CONCLUSIONS In patients with breast cancer liver metastases undergoing locoregional therapy, RECIST categorization may not be an accurate reflection of treatment response.
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Affiliation(s)
- Adeel R Seyal
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Keyur Parekh
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Yuri S Velichko
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Riad Salem
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Vahid Yaghmai
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611.
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31
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Dimitroulis D, Tsaparas P, Valsami S, Mantas D, Spartalis E, Markakis C, Kouraklis G. Indications, limitations and maneuvers to enable extended hepatectomy: Current trends. World J Gastroenterol 2014; 20:7887-7893. [PMID: 24976725 PMCID: PMC4069316 DOI: 10.3748/wjg.v20.i24.7887] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/11/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
The liver is a solid organ with a wide variety of primary benign or malignant tumors as well as metastatic lesions. Surgical resection of these tumors remains the only curative modality. Several limitations, however, do not allow the performance of these operations. This review evaluates the indications and limitations regarding these extended hepatic resections, as well as describing all the manipulations that increase the candidates for such operations. A thorough review of the literature was performed in order to define indications for extended hepatectomy, as well as to present all methods that contribute to increasing the volume of the future remnant liver. The role of portal vein ligation, portal vein embolization, two-stage hepatectomy, and in situ liver transection are evaluated in the setting of indications and results. Extended hepatectomies are a necessity due to oncological reasons. All methods developed in order to increase the volume of the remnant liver are safe and efficient. in situ liver transection is a novel and revolutionary two-step procedure for extended hepatic resections. Further clinical studies are required to estimate long-term results and the oncological basis of this technique.
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Liver resections of isolated liver metastasis in breast cancer: results and possible prognostic factors. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2014; 2014:893829. [PMID: 24550602 PMCID: PMC3914465 DOI: 10.1155/2014/893829] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 01/08/2023]
Abstract
Background. Breast cancer liver metastasis is a hematogenous spread of the primary tumour. It can, however, be the expression of an isolated recurrence. Surgical resection is often possible but controversial. Methods. We report on 29 female patients treated operatively due to isolated breast cancer liver metastasis over a period of six years. Prior to surgery all metastases appeared resectable. Liver metastasis had been diagnosed 55 (median, range 1–177) months after primary surgery. Results. Complete resection of the metastases was performed in 21 cases. The intraoperative staging did not confirm the preoperative radiological findings in 14 cases, which did not generally lead to inoperability. One-year survival rate was 86% in resected patients and 37.5% in nonresected patients. Significant prognostic factors were R0 resection, low T- and N-stages as well as a low-grade histopathology of the primary tumour, lower number of liver metastases, and a longer time interval between primary surgery and the occurrence of liver metastasis. Conclusions. Complete resection of metastases was possible in three-quarters of the patients. Some of the studied factors showed a prognostic value and therefore might influence indication for resection in the future.
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