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Review
. 2023 Jan 30:13:1083297.
doi: 10.3389/fonc.2023.1083297. eCollection 2023.

Locoregional treatment of de novo stage IV breast cancer in the era of modern oncology

Filippo Merloni  1 , Michela Palleschi  1 , Caterina Gianni  1 , Chiara Casadei  1 , Annalisa Curcio  2 , Antonino Romeo  3 , Maddalena Rocchi  2 , Simona Cima  3 , Marianna Sirico  1 , Samanta Sarti  1 , Lorenzo Cecconetto  1 , Marita Mariotti  1 , Giandomenico Di Menna  1 , Ugo De Giorgi  1
Affiliations
Review

Locoregional treatment of de novo stage IV breast cancer in the era of modern oncology

Filippo Merloni et al. Front Oncol. .

Abstract

Approximately 6% of metastatic breast cancers arise de novo. 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 Both retrospective and prospective studies suffer several limitations, ranging from selection bias and outdated ST to a small sample of patients.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.

Keywords: breast cancer; locoregional treatment; primary tumor; radiotherapy; stage IV; surgery.

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Conflict of interest statement

UD received honoraria for advisory boards or speaker fees for Pfizer, BMS, MSD, PharmaMar, Astellas, Bayer, Ipsen, Roche, Novartis, Clovis, GSK, AstraZeneca, Institutional research grants from AstraZeneca, Sanofi and Roche. MP has received advisory board fees from Novartis. All other authors confirm that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Aggressive approach combining modern systemic therapy, locoregional treatment of the primary tumor and metastases-directed therapy in stage IV de novo oligometastatic breast cancer patients.
See this image and copyright information in PMC

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