Loco-regional therapy and breast cancer survival: searching for a link

Abstract

Objective: The relationship between loco-regional (LR) control and breast cancer survival was investigated with the intention of generating a new biological hypothesis to explain some of the paradoxes unaccounted for by the prevailing conceptual model of the disease.

Background: The progressive reduction of surgical aggressiveness has been accompanied by an increase of breast cancer survival mainly attributed to the adoption of adjuvant systemic therapies. More recently, it has been recognized that effective LR control may prolong the survival of breast cancer patients, although the reasons for this improvement have not yet been clearly defined.

Methods: The literature (PubMed) was reviewed for publications related to breast cancer LR treatments using the following key words: breast cancer surgery, breast cancer radiotherapy, breast cancer loco-regional control, breast cancer survival.

Results: Although breast cancer is frequently a multifocal disease, neither mastectomy nor whole breast irradiation are always mandatory to obtain adequate local control. Conversely, selected groups of patients carry a particularly elevated risk of LR relapse and require more effective treatments to be developed. True LR recurrences are associated with a decreased overall survival and this may be related to a complex relationship between circulating tumor cells, re-seeding of the primary tumor site and several metabolic effects linked to the act of surgery.

Conclusion: The prevention of LR recurrences is a major goal of breast cancer care, which requires a better understanding of the complex relationships between the primary tumor and its metastatic process.