¿Está indicada la irradiación del tumor primario en el estadio IV?

Abstract

De-novo metastatic breast cancer is a rare entity, occurring in 3–10% of cases. The most common treatment for these patients is systemic therapy (chemotherapy, hormonal therapy, targeted therapies, and combinations of these). The subgroup of patients with oligometastatic disease and low systemic disease burden may benefit more from adding a locoregional treatment. This literature review aims to analyze the benefits and disadvantages of locoregional treatment in patients with de-novo oligometastatic breast cancer. Retrospective series report that this subgroup of patients may benefit from locoregional treatment, despite presenting with metastatic disease, by improving overall survival and local control. Additionally, several retrospective series have shown that locoregional treatment with surgery, surgery and adjuvant radiotherapy, or exclusive radiotherapy present similar results in local control. Therefore, exclusive radiotherapy may be a viable alternative in these patients. In recent years, attempts have been made to demonstrate the trend of retrospective series in prospective trials. These studies have shown great heterogeneity. Some with positive results in improving overall survival and others with negative results, but not statistically significant. The main limitation of retrospective series is the selection bias, which could explain the differences in the results obtained. For this reason, locoregional treatment in these patients should be approached by multidisciplinary teams on an individualized basis, with greater consideration for oligometastatic patients.