Updated Guidelines for Surgery/Radiation in MBC Setting?

[Half-Full]

I’ve seen several posts from members who are pursuing localized radiation treatments and possibly even surgical removal of distant metastases in an MBC setting. My wife has a relatively conservative oncologist who seems to still believe that surgery and even radiation offer no benefit and should not be considered in an MBC setting.

I would appreciate understanding the perspectives that any of you who might have who are in this situation, and what the perspectives are of your oncologists.

I do recall seeing some papers a few years ago that seemed to suggest the thinking might be gradually changing on this, and that the selective removal of distant metastases may have some benefit to survivability, but I can’t seem to find any new data/studies on this now.

Of course, each metastasis is different. But as an example, my wife has an enlarged Hilar lymph node that is presumed to be affected by her MBC. It seems to be stable at this point, but it would seem there might be an argument to remove it while her targeted therapy is working instead of waiting for it to become an issue down the road?

Many thanks for any thoughts/experiences.

[Ardie1970]

I can only speak for myself. I had an ulcerating tumor on my breast and pushed for a year to get a mastectomy. Finally after suffering from a cellulitis (Strep) infection my doctors relented always saying it will not improve my outcome. My surgery was on December 27. I can tell you I feel better now than I have in a long time. I have a lot more energy. I have Mets in my liver though and am not a candidate for surgical intervention there due to the number of Mets and how widespread they are. If I only had one or two Mets, I would be pushing for resection.

[Thredbo2]

I hope all goes well for your wife. My oncologist seems to believe in surgery/radiation for oligo metastatic Mets. I currently have a solitary bone met in my proximal femur, one off radiation in 2018, Xgeva, Letrozole and Palbociclib controlled it for 2 1/2 years but now it’s progressing. He has been monitoring me closely with 3-4 monthly PET scans and no further mets have appeared. (Also had additional axilla Mets removed and radiation 2 years ago and they are gone. )So I’m now booked to have a full hip replacement to remove the solitary bone met in a couple of weeks which will be followed by another dose of radiation and my team seems pretty sure it will delay further outbreaks, prevent fracture in the future and may even cure! (I hope they are right). It would be nice to have a crystal ball, I am going along with their suggestion as they are so positive but am a bit nervous.

[love2golfwell]

I have had SBRT (stereotactic body radiation therapy) for 2 bone lesions, one on the ischium and one on the sacrum. They were targeted radiation treatments of 5 sessions each and seemed to have worked as they have been stable or gone on my last 2 scans. I am currently on Ibrance and Letrozole for over a year and have a scan next month so we shall see. Best of luck to you wife. Hope you get some solutions.

[Iwasborntodothis in reply to love2golfwell]

I had similar good results from 5 rounds to my hip and pelvis

[love2golfwell in reply to Iwasborntodothis]

I was terrified to have this radiation done, having heard stories of all kinds of side effects. However, it was really quick and painless. I had the most wonderful radiation oncologist and her team was great, too. They explained everything to me, were kind and gentle and supportive. I was back to playing golf afterwards, the main thing I was worried about!

[Iwasborntodothis in reply to love2golfwell]

Amen sista we need to keep our priorities straight! My husband and I are having a great time playing a little short course in Scottsdale this winter at the Mountain Shadows Resort and the little municipal 9 hole course ($10 a round) by our house. It's too expensive to golf in Scottsdale this time of year, Also, we have tickets for the Phoenix Open golf tournament that is coming up in February so pretty excited about that.

[love2golfwell in reply to Iwasborntodothis]

Golf is definitely a priority for me. I feel it is keeping me alive and doing well, not just the challenge of the game itself, but the people I get to play with, the beauty of our 2 courses, the incredible wild life and of course the sunshine and warm weather! Have fun playing and have a great time at the tournament!

[NShaft]

I talked to my onc about surgery. His response was with the removal of lymph nodes there is always risk of lymphedema. You would need to weigh that risk. I have read on this board that some who have had surgery just feel more positive to have the lesions removed. With MBC everything is a gamble but state of mind, I feel, can be as important as medical treatments in treating this disease.

[Half-Full]

Thanks for all the replies. It would be nice if there were some studies on this since there seems to be widely varying opinions on the merit. Interesting point about the state of mind benefit, I hadn't considered that but I wholeheartedly agree.

[queeneee]

I don't have any info on bone mets, but here is some research into liver ablation. My onc is 'against' because he says it doesn't prolong life.. I argue for QOLife. ncbi.nlm.nih.gov/pmc/articl... ...and...pubmed.ncbi.nlm.nih.gov/240........ in fact there is some evidence for slightly longer life