What is the best treatment option in postmenopausal, hormone responsive breast cancer patients with isolated bone metastases?

BACKGROUND: Bone is the most common metastatic site for breast cancer. AIM: To determine the effectiveness of addition of chemotherapy to hormonal therapy in postmenopausal hormone receptor-positive breast cancer patients with isolated bone metastases. MATERIALS AND METHODS: Between June 2001 and January 2007, 101 patients were classified into two groups according to initial treatment modalities; patients who received hormonotherapy only (group I) and chemotherapy followed by hormonotherapy (group II). The effect of treatment choice on clinical course, time to progression, and overall survival were evaluated. RESULTS: There were 70 patients in group I and 31 patients in group II. Bone metastases in 27 patients (26.7%) were synchronous and the remainder were metachronous. The median follow-up time was 41 months. The two groups showed similar results when patients' tumor characteristics were compared. However, 81% of synchronous cases had upfront chemotherapy following hormonotherapy, whereas this ratio was only 12% in the metachronous group. All patients received systemic antiresorptive bisphosphonates whereas only 24 patients required palliative radiotherapy at some time during the course of their disease. In groups I and II, the median time to progression was 12 and 16 months (P: 0.96) and median overall survival was 41 and 40 months (P: 0.79), respectively. In HER-2-positive patients, a trend of prolongation of overall survival was observed in group II, but it was not statistically significant (P: 0.12). CONCLUSIONS: Anti-hormonal therapy still seems to be considered as the ideal treatment of choice for postmenapousal breast cancer patients with isolated bone metastases.

Clinical importance of preoperative detection of the apical lymph node metastasis in patients with breast carcinoma.

INTRODUCTION: According to the revised staging system for breast cancer, the infraclavicular node status has become more important because the involvement of the apical nodes now changes the stage of the disease for all tumour sizes. In this study, we analysed the stage migration among our patients treated with mastectomy for breast cancer. METHODS: 44 patients who were treated with modified radical mastectomy for breast cancer in our department during 2003 were reviewed for their clinicopathological features, including the status of the axillary lymph nodes. RESULTS: 11 patients (25 percent) were reclassified as stage IIIC according to the new Tumour, Node and Metastasis (TNM) classification system of American Joint Committee on Cancer that was revised in 2002. The mean age was 40.2 years and the mean tumour size was 5 cm. CONCLUSION: Patients with breast cancer should be properly staged preoperatively for choosing appropriate individual treatment, and more accurate evaluation of the infraclavicular region for metastatic lymph nodes should be done.