Treatment of primary breast tumors in de novo metastatic breast cancer.

BACKGROUND: De novo metastatic breast cancer accounts for about 3% to 6% of the more than 200,000 new breast cancer cases annually in the United States. The treatment of the primary breast tumor in these cases is a widely debated topic. Some feel that surgical resection of the breast tumor is appropriate for selected patients, whereas others recommend surgical resection only to treat or prevent uncontrolled chest wall disease. METHODS: We review the published data on treatment of the primary tumor in de novo metastatic breast cancer, including retrospective population-based and single-institution studies. We then report on the first 2 randomized controlled trials (RCTs) that evaluated the effect on survival of surgical resection of the primary breast tumor. RESULTS: Results of the published retrospective analyses are varied, but in general they associate resection with improved outcome. Early results from the first RCTs point to no survival advantage with resection of the primary tumor in this population, but important limitations of the RCTs are noted. CONCLUSIONS: The early data from RCTs do not show survival benefit from surgical resection of the primary tumor in de novo metastatic breast cancer, but these studies have some important limitations and also suggest that certain subsets may benefit. The question therefore remains unanswered, which should provide greater impetus for the completion of ongoing RCTs.