Abstract
Background
The role and outcome of radical surgery in contemporary multidisciplinary management of breast cancer patients presenting with isolated sternal or full-thickness chest wall (SCW) recurrence are undefined compared with patients treated without surgery.
Methods
Detailed analyses of all patients with isolated SCW recurrence treated from 1992 to 2011 at a large cancer institution were performed. Univariate and multivariate comparisons of clinicopathologic and treatment characteristics were analyzed. Overall and progression-free survival were compared using the Kaplan–Meier method.
Results
Seventy-six patients were identified, 44 treated surgically and 32 nonsurgically. Overall survival at 5 years was not statistically different between patients who underwent surgery and those who did not (30.6 and 49.6 %, respectively; P = 0.52) although patients selected for surgery presented with more advanced and biologically aggressive disease. Surgically treated patients were more likely to have triple-negative breast cancer at recurrence (52 vs. 17 %; P = 0.006). Among surgical patients, 95 % received preoperative systemic therapy. Clinical response with systemic therapy was significantly different, with surgically treated patients more likely to have responsive or stable disease (54 vs. 25 %, P = 0.04). Complications related to radical surgical resection occurred in 25 % of patients. For hormone receptor–positive recurrence, 5-year progression-free survival was significantly higher among surgical patients (46.3 vs. 14.5 %; P = 0.01).
Conclusions
Among patients with isolated SCW recurrence, hormone receptor-positive recurrence is associated with improved survival. Systemic therapy should be the initial treatment, and clinical response can be used to help select patients who may benefit from radical resection.
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Acknowledgment
The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health through Cancer Center Support Grant CA016672.
Conflict of interest
Dr. Selber is a scientific advisor for TEI Biosciences. All other authors declare that no conflict of interest.
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Michelle C. Shen and Nader N. Massarweh contributed equally to this study.
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Shen, M.C., Massarweh, N.N., Lari, S.A. et al. Clinical Course of Breast Cancer Patients with Isolated Sternal and Full-Thickness Chest Wall Recurrences Treated With and Without Radical Surgery. Ann Surg Oncol 20, 4153–4160 (2013). https://doi.org/10.1245/s10434-013-3202-4
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DOI: https://doi.org/10.1245/s10434-013-3202-4