of Paolo Veronesi
The intervention is not currently foreseen by the guidelines if the neoplasm is diagnosed in the metastastic phase, but the results of a study show that removing it can help prolong survival
A friend was diagnosed with stage 4 breast cancer and already has some metastases. Now she is completing the necessary tests to better understand how to proceed, but she has already been told that the surgery for her case is not foreseen. I was very perplexed: a correct approach? Or rather ask for another consultation? He is 69 years old and has no other diseases. Thank you
He answers Paolo Veronesi, director of the Breast Program and of the Surgical Breast Division at the European Institute of Oncology in Milan. President of the Umberto Veronesi Foundation
National and international guidelines, in fact, do not provide for the removal of breast cancer when it is diagnosed in its most advanced stage with metastatic spread to other organs: bones, liver, lungs are the most frequent sites. Based on the patient’s subtype of breast cancer, systemic therapy is prescribed, ie drug-based therapy, with the aim of prolonging survival and improving the quality of life as much as possible. Huge progress has been made in this field and nowadays there are many medicines available (from chemotherapy to those with molecular targets, from hormonal treatments to experiments with immunotherapy and numerous other molecules), to which radiotherapy is added, if indicated, for example to reduce pain associated with bone metastases. Thanks to the numerous effective options that have arrived in recent years, the average life expectancy of women who receive a diagnosis of metastatic breast cancer is now around five years, but this is a figure that hides a great variability conditioned by how much the extended tumor, from which organs it affected, from the age and state of health of the patient and above all from its biological characteristics that give us an indication of the possible response to therapies.
The study of the utility of surgery
Precisely for this reason, the question is increasingly asked whether it may not also be useful to remove the neoplasm and the results of some studies seem to go in this direction. In this regard, in the scientific journal Annals of Surgical Oncology, American researchers have recently published the results of an analysis conducted on the data of about 13 thousand patients with fourth stage breast cancer, all treated with different drugs and, in part, subjected to surgery. surgical. The results show that removing the tumor after medical treatment can help extend survival: women operated on to remove the tumor are in fact more likely to be alive five years after diagnosis than those treated only with systemic therapy. This appears even more true in particular for patients with a hormone receptor and / or HER2 antigen positive tumor and independent of the type of surgery received. That is, an advantage is gained in survival both with mastectomy (complete removal) of a single breast or both, and with lumpectomy (partial removal). The benefits have not been considered relevant if you proceed first with the scalpel and then with the drugs.Of course we need further confirmation on greater numbers of participants and targeted studies on this issue before being sure that this should be the new standard approach for all the sick in the fourth stage, but a very lively question in the scientific community. And among the aspects in favor of surgery, as pointed out by the American colleagues who wrote the study, the safety and speed of modern breast cancer surgery, which involves short hospitalizations and no or minimal complications in the vast majority of cases.
July 14, 2021 (change July 14, 2021 | 19:16)
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