Methods: Using the key words "surgery stage IV breast cancer", a PubMed search for all related articles published in the English language, between January 1999 to December 2009, was done. Of 292 articles yielded by the search, 25 articles focused on the impact of surgery in stage IV breast cancer. Full texts of these of these articles were then collated for this review. Results: No randomized controlled trials comparing the outcome of surgery versus no surgery in metastatic breast cancer have been published thus far. The search yielded only heterogenous data from several retrospective studies for which no systematic reviews or meta-analysis had been done. A summary of these retrospective data was done and reported herein. The reports are grouped into two: those based on population registries, and those coming from single institutions.
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Purpose: Although adjuvant chemotherapy (CTx) is still recommended for high-risk patients with hormone receptorpositive and human epidermal receptor (HER)-2-negative breast cancer, recent studies found that selected patients with low disease burden may be spared from CTx and receive hormonal treatment (HT) alone. This study aims to evaluate the trends of treatment (CTx + HT vs. HT alone) in Korea and to assess the impact on overall survival (OS) according to treatment pattern. Methods: The Korean Breast Cancer Society Registry was queried (2000 to 2018) for women with pT1-2N0-1 hormone receptor-positive and HER2-negative disease who underwent surgery and adjuvant systemic treatment (CTx and HT). Clinicopathologic factors, change in pattern of treatment over time, and OS for each treatment option were analyzed. Results: A total of 40,938 women were included in the study; 20,880 (51.0%) received CTx + HT, while 20,058 (49.0%) received HT only. In recent years, there has been a steady increase in the use of HT alone, from 21.0% (2000) to 64.6% (2018). In Cox regression analysis, age, type of breast and axillary operations, T and N stages, body mass index, histologic grade,and presence of lymphovascular invasion were prognostic indicators for OS. There was no significant difference between CTx + HT and HT alone in terms of OS (P = 0.126). Conclusion Over the years, there has been a shift from CTx + HT to HT alone without a significant difference in OS. Therefore, HT alone could be a safe treatment option in selected patients, even those with T2N1 disease.

Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors.
Malignant Phyllodes tumor ; breast