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World J Clin Oncol. May 10, 2014; 5(2): 82-85
Published online May 10, 2014. doi: 10.5306/wjco.v5.i2.82
Resection of the primary tumor in stage IV breast cancer
Tadahiko Shien, Hiroyoshi Doihara
Tadahiko Shien, Hiroyoshi Doihara, Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, 7008558 Okayama, Japan
Author contributions: Doihara H contributed to this paper; Shien T designed and wrote the introductory editorial for the Highlight Topic: “Resection of the primary tumor in stage IV breast cancer”.
Correspondence to: Tadahiko Shien, MD, PhD, Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, 7008558 Okayama, Japan. tshien@md.okayama-u.ac.jp
Telephone: +81-86-2357265 Fax: +81-86-2357265
Received: December 28, 2013
Revised: January 23, 2014
Accepted: March 11, 2014
Published online: May 10, 2014
Processing time: 135 Days and 8.2 Hours
Abstract

Stage IV breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage IV is intended to “prolong survival and palliate symptoms”. Resection of a primary tumor is considered to be “effective only at alleviating chest symptoms and providing local control” in spite of the advances of imaging examination and medication for breast cancer. Molecular target and endocrine drugs are very effective and useful to tailor-make a treatment strategy according to breast cancer subtypes. Positron emission tomography-computed tomography can detect and diagnose the very small metastases and recurrences which can potentially be cured even if they are distant metastases. Recently, many retrospective studies have reported the survival benefit of surgery for breast cancer patients with metastases and some clinical trials which confirm the surgical prognostic benefit for them have started to enrol patients. The goal of treatment has to be clearly identified: increase the patient’s survival time, provide local control or perform histology to determine the cancer’s properties. The best evidence is absolutely essential to treat patients who need surgery at the right time. We need to evaluate the treatment strategy, including primary resection for stage IV breast cancer particularly, and find new evidence by prospective analysis.

Keywords: Breast cancer; Metastasis; Surgery; Survival; Stage IV; Clinical trial

Core tip: Resection of a primary tumor of stage IV breast cancer was considered to be “effective only at alleviating chest symptoms and providing local control” in spite of the advances of imaging examination and medication for breast cancer. Recently, many retrospective studies have reported the survival benefit of surgery for breast cancer patients with metastases and some clinical trials which confirm the surgical prognostic benefit for them have started to enrol patients. We need to evaluate the treatment strategy, including primary resection for stage IV breast cancer particularly, and find new evidence by prospective analysis.