Merloni Filippo, Palleschi Michela, Gianni Caterina, Casadei Chiara, Curcio Annalisa, Romeo Antonino, Rocchi Maddalena, Cima Simona, Sirico Marianna, Sarti Samanta, Cecconetto Lorenzo, Mariotti Marita, Di Menna Giandomenico, De Giorgi Ugo
Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
Breast Surgery Unit, Pierantoni-Morgagni Hospital Forlì and Santa Maria delle Croci Hospital Ravenna, Forli, Italy.
Front Oncol. 2023 Jan 30;13:1083297. doi: 10.3389/fonc.2023.1083297. eCollection 2023.
Approximately 6% of metastatic breast cancers arise . While systemic therapy (ST) remains the treatment backbone as for patients with metachronous metastases, locoregional treatment (LRT) of the primary tumor remains a controversial method. The removal of the primary has an established role for palliative purposes, but it is unclear if it could also determine a survival benefit. Retrospective evidence and pre-clinical studies seem to support the removal of the primary as an effective approach to improve survival. On the other hand, most randomized evidence suggests avoiding LRT. Both retrospective and prospective studies suffer several limitations, ranging from selection bias and outdated ST to a small sample of patients. In this review we discuss available data and try to identify subgroups of patients which could benefit the most from LRT of the primary, to facilitate clinical practice decisions, and to hypothesize future studies design on this topic.
约6%的转移性乳腺癌会出现这种情况。对于异时性转移患者，全身治疗（ST）仍是治疗的主要手段，而原发肿瘤的局部区域治疗（LRT）仍是一种存在争议的方法。切除原发灶在姑息治疗方面有既定作用，但尚不清楚其是否也能带来生存获益。回顾性证据和临床前研究似乎支持切除原发灶是改善生存的有效方法。另一方面，大多数随机对照证据表明应避免进行局部区域治疗。回顾性和前瞻性研究都存在若干局限性，从选择偏倚、过时的全身治疗到患者样本量小等问题。在本综述中，我们讨论现有数据，并试图确定最能从原发灶局部区域治疗中获益的患者亚组，以促进临床实践决策，并对该主题未来的研究设计提出假设。
