By David Douglas

NEW YORK (Reuters Health) – Surgical resection of isolated pulmonary metastases can prolong overall survival in breast cancer patients, German researchers say.

“On the basis of our findings, we highly recommend that surgeons should consider patients with isolated pulmonary metastases for surgical resection,” Dr. Georgios Meimarakis told Reuters Health by email. “For various reasons, and too often, it is assumed that these patients would not benefit from surgical interventions and thus such treatment is not made available.”

In the April issue of the Annals of Thoracic Surgery, Dr. Meimarakis and colleagues at Ludwig-Maximilians-University, Munich, note that lung metastases develop in as many as 40% of breast cancer patients.

For the present study, the researchers examined data on 81 patients who underwent pulmonary metastasectomy. In 66 (81.5%), an R0 resection was achieved. Six had an R1 resection and R2 was achieved in the remaining nine.

Dr. Meimarakis said in a statement that no randomized trials have compared survival after metastasectomy vs conservative therapeutic strategies.

Median overall survival was significantly greater in the R0 patients, at 103.4 months, versus 23.6 months in the R1 group and 20.2 months in R2 patients.

In comparison, the median survival of patients treated with conventional chemotherapeutic regimens ranges from 12 months to 24 months, according to the research team.

The findings are also in line with those of another study which showed five-year overall survival rates of 36% in patients treated surgically and 11% in those managed conservatively.

These and other results, say the researchers, “challenge the notion that surgical treatment in patients with metastasized breast cancer is unnecessary and of value only for extremely selected patients.”

In the current study, there was a trend in univariate analysis toward increased survival in patients with negative lymph nodes (103.4 vs 32.1 months).

The authors also point out that patients with multiple pulmonary lesions or metastases with histologically-proven negative hormone receptor (HR) status are at greater risk of relapse. They say “additive treatment tailored to the biological subtype defined by HR expression should be considered for this group.”

The author of an editorial, Dr. Hans Hoffmann of The University of Heidelberg, Germany, told Reuters Health by email, “A newly detected pulmonary nodule may not necessarily be a metastasis from a previous breast cancer.”

“Specifically,” he said, “the proportion of lesions proved not to be breast cancer metastases in various series ranges from 7% to 66%. Therefore, removal of the pulmonary nodule is recommended for two reasons. First, it is of diagnostic importance, allowing for differential diagnosis with second primary lung cancers and benign lesions. Second, complete resection of pulmonary oligometastatic disease may prolong survival.”

“Moreover,” he concluded, “the morbidity of lung resections has been reduced in recent years and…removing a solitary lesion is a smaller price to pay than formerly.”

SOURCE: Prolonged Overall Survival After Pulmonary Metastasectomy in Patients With Breast Cancer
Ann Thorac Surg 2013;95:1170–1180.