Treatment of stage IV breast cancer with intact primary tumor: A case for resection?

Surgical removal of the intact primary breast tumor for patients who present with stage IV disease remains controversial. The classical view is that resection of the intact primary will have no survival benefit in stage IV disease; however, resection may prevent the development of uncontrolled chest wall disease. Multiple retrospective reviews have compared survival in stage IV patients who do or do not undergo resection of the intact primary, and have demonstrated longer survival with the use of primary site surgery. These are all compromised by the selection of women with favorable characteristics for surgical therapy and the inability to confirm important disease and treatment parameters in registry and retrospective data. Additionally, there are no data that allow examination of the value of radiotherapy in addition to surgery. These important questions cannot be addressed without Level 1 evidence, and randomized trials comparing primary site therapy versus none are ongoing.