December 12, 2013 | by Nicole White
As treatment options expand, and researchers learn more about individual tumors, a critical component of cancer treatment becomes determining the most effective tool to treat an individual patient.
Equally important to knowing when to perform a surgery is knowing when not to. Breast cancer experts debate the benefits of offering surgery and radiation to women with metastatic breast cancer – advanced-stage breast cancer that has spread to other parts of the body – who are already responding to chemotherapy.
A study presented this week at the San Antonio Breast Cancer Symposium aimed to settle the long-running dispute. The findings: For women with these kinds of breast cancers, surgery and radiation did not offer any additional benefits.
“We’ve actually been able to see drugs completely resolve small distant metastases and all that’s left is in the breast,” Courtney Vito, M.D., a surgical oncologist at City of Hope, told the Los Angeles Times in an interview. “Well, what do you do with those women?”
The study confirmed Vito’s preference to leave the breast tumor alone if chemotherapy is working favorably. However, she does not think that the study will be sufficient to settle the debate among the medical community.
“For people in the camp that think Stage IV mastectomy is valuable, this probably will not be enough,” she said.
The researchers, at Tata Memorial Hospital in Mumbai, India, sought to determine if surgery and radiation extended a patient’s survival. They enrolled 350 Indian women diagnosed with metastatic breast cancer who responded positively to chemotherapy.
Of the study participants, 177 continued with chemotherapy only, while 173 had surgery and removal of nearby lymph nodes, followed by radiation therapy. About a year and a half later, 218 of the patients participating in the study had died, including 107 from the chemotherapy-only group and 111 who received surgery and radiation.
Statistically, the outcomes for the groups were the same.
Vito said attempts to conduct similar studies in the United States have failed due to problems enrolling patients.
“Women who believe that removing their breast will help them don’t want to be randomized and let the trial decide if they get surgery or not,” she said. “It’s the same for patients who don’t want to get surgery … Some people say a study like this would never be able to be done, and it looks like these authors have done it and come up with an answer.”
In the U.S., most breast cancer cases are identified in earlier stages, when they are easier to treat successfully. About 5 t0 10 percent are found after they have already spread. In developing countries, where medical care is not as advanced, as many as 20 percent of cases are diagnosed after the breast cancer has metastasized.