Precise selection of breast cancer patients with bone metastasis for endocrine ablation.

To enhance the precision of selection of breast cancer patients with bone metastasis for endocrine ablation, 85 patients underwent a Levodopa test for 4 consecutives days. Assessment of the result of the test was made on the basis of thorough clinical evaluation, x-ray examination, and results of serum and skin tests as well as cancer receptor studies when tissue was available. Results of 23 surgical procedures were as follows: bilateral oophorectomy elicited good clinical response in five patients with positive preoperative Levodopa tests; one negative clinical response followed a negative Levodopa test; bilateral adrenaloophorectomy in nine patients elicited good response in seven who had positive Levodopa tests and negative responses in two patients who had negative Levodopa tests; bilateral adrenalectomy in eight patients elicited good response in five patients with positive Levodopa tests and negative responses in three who had negative Levodopa tests. There were no deaths and there was only one complication after operation. Levodopa testing appears to be an effective means for selection of patients with bone pain from recurrent breast cancer who will benefit from endocrine ablation. When the Levodopa test was negative for bone pain relief, endocrine ablation was of no benefit to the patient.