Abstract
Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy. However, there is mounting evidence that resection of the primary tumour and/or localised radiotherapy (locoregional therapy; LRT) could be associated with overall survival improvements. We aimed to conduct a meta-analysis to inform decision making. Using the PubMed, Cochrane and Ovid SP databases, a literature review and meta-analysis were conducted to assess the effect of LRT on overall survival. Studies were analysed for the impact of LRT on survival. All forms of LRT resulted in a significant 31.8% reduction in mortality (N = 42; HR = 0.6823 (95% CI 0.6365; 0.7314)). Surgical resection resulted in a significant 36.2% reduction in mortality (N = 37; HR = 0.6379 (95% CI 0.5974; 0.6811)). The prospective trials reported a 19.23% reduction in mortality which was not statistically significant (N = 3, HR = 0.8077 (95% CI 0.5704; 1.1438). 216 066 patients were included. This is the largest meta-analysis regarding this question to date. Our meta-analysis shows that LRT of the primary tumour seems to improve overall survival in de novo stage IV disease. Therefore, this therapeutic option should be considered in selected patients after a careful multidisciplinary discussion.
Highlights
Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy
We evaluated the null hypothesis, which specified that all treatment effects were equal to zero and all hazard ratios (HRs) equate to 1
As discussed above, there is mounting evidence that the primary tumour continues to play a role in metastatic disease, which would account for the benefits ascribed to locoregional therapy (LRT)
Summary
Patients presenting with de novo stage IV metastatic breast cancer have a complex disease which is normally treated with palliative intent and systemic therapy. Our meta-analysis shows that LRT of the primary tumour seems to improve overall survival in de novo stage IV disease. This therapeutic option should be considered in selected patients after a careful multidisciplinary discussion. In order to better assess the literature surrounding this question, we performed a meta-analysis of the available studies pertaining to LRT in de novo stage IV breast cancer and its implications for patient survival. This is an update of our previously published meta-analysis[16]
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