Has anyone ever been offered surgery for bone mets?

Anonymous

Has anyone ever been offered surgery for bone mets?

DivineMrsM

Coffee, not sure exactly what your question is, but I was diagnosed stage iv bone mets from the start and had chemo, a lumpectomy and radiation, then started on an aromatase inhibitor.

exbrnxgrl

I think we have a few stage IV members who have had surgery. I assume you're referring to mastectomy, and I hope they will see this and post. I had a bmx about 6 weeks before my stage IV dx but not sure that would have happened had it been known that I was already stage IV.

I know you really want surgery from prior posts. I wish you the best and although uncommon I know that it has been done.

** I just re-read the op. Wereyou asking about surgery for bone mets or mastectomy?

exbrnxgrl

Well, I certainly made a hash of answering you!

I have never heard of surgery to remove a bone met, but that doesn't mean there isn't such a thing. Most bone mets are resolved through chemo or radiation. I had rads x15 almost 10 years ago and the met, while visible on imaging, remains inactive. Not sure what you mean by “another case of stage IV, no surgery for you" but my understanding is that surgical removal is simply not a tx for bone mets.

As far as surgery to the primary tumor you already know the answer. Most research indicates there is no treatment value in mastectomy for those initially dx'ed with MBC. There is another school of thought that it, mastectomy, may be helpful in reducing overall tumor burden but that has not really changed much in actual practice. Again, no one is arbitrarily saying no surgery for stage IV but the current research basedstandard of care doesn't support it. This doesn't mean standard of care won't change if medical evidence supports it but it's not there yet. Take care.

moth

bone surgery is sometimes offered for primary bone tumors - like sarcoma for example. But for a breast cancer pt, I've only seen surgeries offered for palliative pain relief if the tumors are impinging on nerves. I'm not sure if by early stage you meant early stage bone cancers? Because early stage breast cancer pts would never have bone mets because by definition bone mets make you stage IV.

You can treat bone mets with radiation though - certain radiation protocols can effectively kill a tumor and then the healthy bone will regrow around it.

I know your perspective is that we're being treated differently but I think we're being given current evidence based care. If surgical interventions have not been shown to extend life, or have actually been shown to shorten life, they won't be offered.

BevJen

I have read some articles that state that cryotherapy (a local treatment done by interventional radiologists) is sometimes used with bone mets. I don't have any articles saved, but you could google and look for articles about it. Also, if you are going to a large cancer center, you could ask your MO to refer you to an interventional radiologist to get some more information.

moth

I dunno. Metastatic breast cancer is a terminal diagnosis. It's a fatal disease. We dance around it a lot and there are a handful of outliers who get quite a good run with treatments, but there's no cure. Palliative treatment doesn't mean some of us don't live quite a long time but there are afaik *two* presumed cured stage IV breast cancer pts.

ALL of us want to live. Some of us here are essentially guinea pigs, either in clinical trial or outside of it, pursuing localized treatment for oligomets or oligoprogression. We will find out eventually I guess if it translates to better OS. My current plan is to have an oligoprogression bone met radiated.

Have you got a plan for systemic or localized treatments yet? ER+ gives you hormonal and CDK4/6 options. Have you considered clinical trials?

moth

Oh gosh, I'm not trying to talk you out of it. I know there are exceptions. I mentioned the famous ones - they had MY subtype so I'm extra invested in figuring out what was unique about them. We also have here a subforum for stage IV NED peeps. I'm not absolutist about this at all.

I don't know. Our opinions and viewpoints on this vascillate a lot. I've had moments of great despair and moments of equal optimism. The optimism and hope are why I've tried clinical trials & my MO is trying to figure out access to another experimental drug. I wouldn't bother if I wasn't hopeful about one of these things turning this thing around.

illimae

I had surgery (lumpectomy) with my stage IV de novo diagnosis, however, it was offered and approved primarily because I had a low tumor burden (just a single bone met) and was treated with curative intent. Had they found multiple tumors or in multiple locations, I doubt it would have been an option.

moth

Barbara Bigelow (pembrolizumab + chemo) and Judy Perkins (tumor infiltrating lymphocytes)

Barbara occasionally posts here

exbrnxgrl

I agree that research is not infallible and certainly should continue to evolve but... beyond clinical trials, at what point would ethics limit or prevent the use of unproven tx ? I confess to limited knowledge of this aspect of medical care. Should patients be able to ask for and receive any tx they want even if evidence does not strongly support it?I have no professional medical credentials nor answers to those questions but I do teach first grade 😊. The other thing that most of us have to consider is cost. If our insurance does not cover a surgery or tx I would venture to guess it would be unaffordable to many. I really trust my doctors and they fully acknowledge that more progress needs to be made in treating and then curing mbc, but that is why I trust them . I understand that they are doing the best for me with what is currently known and they will adopt new research based approaches as they come about.

I am one of those outliers on bco. No progression since initial tx almost ten years ago but the reality is that it could change in a heartbeat. Yes, you hear that some stage IV patients are being treated with curative intent but what that often means is let's try a bunch of stuff and if that doesn't work we'll try more stuff. Theres little rhyme or reason as to who makes it and who doesn't. It stinks, my friend, it all stinks but it's better than it was ten years ago and it will continue to get better, too slowly but it will.
Your point of view is yours and just as valid as anyone's. No one is trying to change your mind but simply giving you information that you might not have considered. You certainly don't have to like that info but a bit of pragmatism is sometimes helpful. Trust me, there are few here who are satisfied with the slow pace of progress in mbc treatment but we each decide how we need to deal with it. I may be an outlier but there are more of us today than ever so I remain cautiously optimistic.

Anonymous

if you're “oligometastatic" - less than five bone mets, you might be offered radiation to the bone, or you might be able to push for it.

If you have more than five at diagnosis, but you respond to systemic treatment and have either “oligoprogression" or one or two mets that persist, again, you might be offered or can ask for radiation.

It isn't done for widespread mets because that's too much “whack-a-mole" for it to make sense, and I assume, probably too much radiation for a body to handle.

I had more than five at diagnosis but I had a complete response to treatment and then one spine met popped back up and my MO then referred me for rads.

As far as people cured, I have heard tell of a few HER2+ladies who were considered “cured" after years of NED and they were able to stopsystemic treatment.

One who is documented is Barbara Bradfield, who was played by Bernadette Peters in the movie Living Proof. (Available on streaming services)

Anonymous

Only cases of surgery I've seen for removing certain mets is when emergency spine surgery happens and a titanium cage is inserted due to the vertebrae being too instable. But that is a serious surgery for very specific life or mobility threatening situations, its not to support curing the person of mets or prolonging their life. Oh sorry, sometimes ladies have a femur or a hip replaced if they are at risk of similar collapse. Again - its more to protect mobility and quality of life than to promote cure.

Sometimes I feel irritated that for being so far out to the right on the distribution curve in terms of cancer likelihood and status, I still get the treatment that is evidence-based and fits 95% (Im making this number up, but it must be high) of the Stage IV patient set. But I've also learned to pick my battles and let go what can't be changed at this point in time. There is a lot MOs just don't know (why and hows of progression, of tumor change, etc) so while approaches are a bit more personalised than in the past, I would hardly call them completely unique for a disease that is so personal.

Heidihill

https://www.breastcancer.org/symptoms/types/recur_...

It is rare but surgical resection of bone tumor is done.

In my case chemo picked away at the bone mets (only one lesion) and radiation blasted away lingering cells. Same for the primary and lymph nodes, which were resected. I have not been told I am cured but I have been NED 13 years. I did not need surgery in the bone to achieve NED.

My complete remission and long progression free survival may be taken as surrogates for a cure but can also mean dormant cancer that is either quiescent or stable but not detectable in imaging or hematologically. I have not been on any cancer meds for more than a year. Maybe that bolsters the cure story more but maybe not.

exbrnxgrl

heidihill,

Thank you for that link. I knew that surgery was sometimes done to the bone for stabilizing things but was not aware that it might be used to remove a solitary met. I had/have a single bone met but surgery was never suggested and rads killed it off.

I would love to use the word cure and I’m ten years out but I’ve seen even outliers have progression after years of NEAD. Also, I’m not sure about “cure” because even those of us who are NEAD have achieved it through a crazy patchwork of different treatments and approaches which leads me to believe that there is not current cure but some of us just get lucky. BTW, besides rads to my bone my only tx has been aromatase inhibitors. I have never had chemo.

gailmary

I have one met in humerus (upper arm). My MO thought we should do a partial shoulder replacement. The rest of the team did not. The idea freaked me out. I still would have needed to stay on treatment for life and monitor as I do now. I don't know if insurance would have covered it.

Gailmary

SuperDeNovo37

I asked my MO about surgery, and he basically said no due to the extensive nature of my disease. It probably makes sense from an evidence-based standpoint, but it's really hard to hear that. It feels like I'm being written off as hopeless.

He said in some cases it does make sense, and he mentioned a woman he was treating who only had a met to her rib - so they were doing a mastectomy and also removing her rib! So it does happen in some cases.

exbrnxgrl

SuperDeNovo,

You are not being written off! Please bear in mind that surgical removal of a bone met is simply not an effective treatment in the vast majority of cases because... there is little evidence to support its efficacy. Except in rare instances, I doubt any mo would put a patient through surgery if there was little chance of it helping. I know you feel that it was hard to hear but I think it’s good that your mo was honest instead of putting you through unneeded surgery. To give you some perspective on how rare this is, I have had a bone met for almost ten years and until this thread was started I had never heard of surgical removal of bc bone mets.

The unfortunate reality is there is no real cure for stage IV. Treatments have gotten better and survival times increasing but there is no definitive cure. I am still hopeful because I can look back ten years and see forward progress. Yes, we all want more than that but things really are better for more people now than years ago. Take good care

Sadiesservant

SuperDeNova,

I would add that one cannot underestimate the power of radiation. In the case of limited bone mets, as Exbrngrlso aptly demonstrates, radiation is awesome at eradicating disease and is much less invasive. In my case the rads have been used to control symptoms but I am pretty sure that it blasted my skull mets to oblivion.

Take care.

moth

radiation can also be ablative - either with a technology such as SABR or if the lesion is small enough & not near areas too sensitive to collateral damage, with a large enough dose of traditional rads. I'm going for CT mapping tomorrow to prepare for traditional rads for an asymptomatic bone met in my spine and the RO is pretty hopeful that it will be obliterated. The purpose of treating this oligoprogression is eliminating it, not palliating symptoms... so just to confirm what others are saying - that traditional surgery is not your only option to eliminate a bone met.

exbrnxgrl

Not only is traditional surgery not the only option to eliminate a bone met, it’s an option that is considered to be effective in limited circumstances. For the vast majority of bc bones, surgical removal of a bone met is not considered to be a workable treatment

SuperDeNovo37

Thanks for the replies - I have had radiation to an area of my spine where my vertebrae were fractured. I'm not sure yet how effective it was, but the goal was to prevent further compression/collapse of my spine (which is truly a mess - I'm starting PT soon to hopefully improve.)

To clarify, I also never heard of surgery to remove a bone and was surprised to hear him mention it. I was asking my MO about a mastectomy when he mentioned the rib removal. It seems very uncommon based on this thread!