SAN ANTONIO — Patients with metastatic breast cancer who respond to chemotherapy are unlikely to see any additional benefits from surgery or radiation therapy, according to a new clinical trial.
The randomized, controlled study, which was presented Wednesday at the San Antonio Breast Cancer Symposium, was intended to settle a long-running dispute among oncologists about the best way to treat women whose tumors had spread to other parts of their bodies, said Dr. Rajendra Badwe, director of the Tata Memorial Hospital in Mumbai, India.
“For a surgeon like myself, knowing when to do surgery is important,” said Badwe, who led the trial. “But even more important is knowing when not to do it.”
The message might come as welcome news to some breast cancer patients, who now have medical evidence on their side if they opt to take a pass on painful, invasive procedures that aren’t likely to extend their lives. But for other women with metastatic disease, the message that there’s not much they can do beyond chemotherapy is sure to be unsettling, patient advocates said.
“It can be very disheartening for a woman diagnosed with Stage IV breast cancer to learn that surgery is not recommended for her,” said Musa Mayer, who operates the website . “She may see this as a message of futility.”
In the United States, Canada and Europe, roughly 5 percent to 10 percent of all breast cancer patients are diagnosed after their tumors have already spread. In the developing world, 10 percent to 20 percent of patients have metastatic disease by the time they are diagnosed.
Badwe and his colleagues set out to examine whether surgery and radiation actually did extend a patient’s survival. They enrolled 350 Indian women who were diagnosed with metastatic breast cancer and who also showed a positive response to chemotherapy.
Among the volunteers, 177 continued treatment with chemotherapy only and 173 had partial or complete removal of their breast and removal of nearby lymph nodes, followed by radiotherapy.
Seventeen months later, 218 of the patients had died — 107 from the chemotherapy-only group and 111 from the surgery and radiation group. Overall survival after two years of follow-up was 43 percent among the chemotherapy patients and 40 percent for the patients who had more aggressive treatment.
Statistically speaking, the outcomes for both groups were the same, the authors concluded.
