Solitary metastases

Over the past 30 years, new and advanced breast cancer multimodality treatments have resulted in improved median survival times for patients with metastatic breast cancer. Breast cancer most commonly metastasizes to bone, followed by lung, brain, and liver. Until now, the treatment focus for metastatic breast cancer has been on palliative care rather than cure. However, a more aggressive treatment approach may be appropriate for patients with metastatic disease limited to a solitary lesion or to multiple lesions at a single organ site. Improved diagnostic, staging, and surgical techniques may allow curative surgery in these carefully selected patients with acceptable morbidity and very low mortality. In addition, studies have shown that the molecular phenotype of breast cancer determines the timing, pattern, and outcome of metastatic disease, and metastatic lesions may alter their receptor expression profile from their primary tumor. The main goal of such curative surgery would be prolonged disease-free survival and improved quality of life. Provided that the breast cancer primary is controlled, there is a long disease-free period, and the patient has a good performance status, surgery is an important component in the multimodality approach to breast cancer solitary metastases.