Primary breast cancer with synchronous metastatic disease-indications for local radiotherapy to the breast and chest wall

Aim: To review literature on local therapy in patients with primary metastatic breast cancer with focus on local radiotherapy (RT). Patients and Methods: A Medline search using the key words metastatic breast cancer, primary resection/radiotherapy, local therapy, local radiotherapy was carried out. All original studies in the English language were included in the present review. Results: A total of 27 original studies including more than 33,000 patients with metastatic breast cancer were identified, including two large database analyses (n=25,757). All studies were retrospective in nature. Most studies showed a survival benefit with the addition of local therapy in a metastatic situation. The majority of studies focused on the role of surgery. Fourteen studies (52%) mentioned radiotherapy (RT) in 0.3% to 100% of patients. Six of these studies analyzed the effect of RT separately and five found an additional benefit of RT. Two studies showed best outcomes when RT and surgery were combined. Conclusion: Most retrospective studies showed a survival benefit for local therapy in patients with breast cancer with distant metastases. The role of RT remains unclear. Some reports showed improved outcome with the combination of surgery and RT. This approach should be considered in patients with good survival prognosis in whom local control is important. There are several prognostic factors to aid decision-making. Results of prospective randomized studies are pending.