Limited Treatment for Advanced Cancer May Be Best

Metastatic breast cancer survival longer when surgery and radiotherapy withheld

(RxWiki News) Once cancer spreads, controlling it becomes a much more complex challenge. Researchers looked at the survival benefits of treatment alternatives for advanced breast cancer.

A new study found that women with metastatic breast cancer lived longer when no further treatment was given after an initial round of chemotherapy.

Surgery and radiation therapy did not extend life. In fact, women who did not receive these treatments lived longer than the women who did.

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Rajendra Badwe, MD, director of the Tata Memorial Hospital in Mumbai, India, and colleagues examined the benefits of various treatment approaches for women with metastatic (has spread) cancer.

Between 5 and 20 percent of women are initially diagnosed with breast cancer that has already spread (metastasized) beyond the breast.

The general opinion around the world is that treating the tumor itself — what doctors call loco-regional treatment (LRT) — is not necessary following chemotherapy. However, this opinion is subject to debate.

According to Dr. Badwe and colleagues, “Preclinical evidence suggests that such treatment may facilitate growth of metastatic disease. On the other hand, many retrospective [examination of previous research] analyses in clinical cohorts have suggested favorable impact of loco-regional treatment in these patients.”

Resolving this controversy was the objective of this trial in which 350 women with advanced breast cancer were enrolled between 2005 and 2013.

All of the women had been treated with and responded to standard chemotherapy before entering the trial.

Participants were randomly divided into two groups, and the groups were balanced in terms of age, tumor size and other disease characteristics.

One group had surgery — either removal of the breast (mastectomy) or the tumor and surrounding tissue (lumpectomy) along with the removal of axillary (armpit) lymph nodes. Surgery was then followed by radiotherapy.

The other group of women had no further treatment following the initial chemotherapy.

Both groups also received hormonal therapy after the last round of chemotherapy, if their cancer was driven by hormones.

During the follow-up, the researchers discovered that women who received treatment had a median overall survival of 18.8 months, compared to 20.5 months for the women who were not treated beyond the chemotherapy.

The two-year overall survival rate was 40.8 percent for the treated group and 43.3 percent for the untreated group.

“Loco-regional treatment of the primary tumor and axillary nodes has no impact on overall survival in patients diagnosed with metastatic breast cancer at initial presentation, who have responded to frontline chemotherapy. We were unable to identify any subgroups that are likely to benefit from loco-regional treatment. Such treatment should be reserved for women who need it for palliative reasons,” the authors of this study wrote.

Patrick Maguire, MD, a radiation oncologist with Coastal Carolina Radiation and Oncology in Wilmington, NC, told dailyRx News, “Loco-regional treatment is offered to improve quality rather than quantity of life in most cases.”

Commenting on the study, Dr. Maguire said, “The median follow-up of this trial was only 18 months, so results should be interpreted with some caution. One also wonders whether results would be the same if this trial had been limited to patients with only small amounts of cancer spread, often termed oligometastatic disease.”

The results from this trial were presented at the 2013 San Antonio Breast Cancer Symposium.

This clinical trial was funded by Tata Memorial Center and the Department of Atomic Energy Clinical Trial Center in India.

No conflicts of interest were declared.

Research is considered preliminary before it’s published in a peer-reviewed journal.

Review Date: 
December 11, 2013