What is Breast Cancer?
Breast cancer is one of the most common cancers in women, with many cases detected early through screening. Cases of breast cancer that spread to the abdominal cavity are rare but serious. In select cases, cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has shown potential to improve survival and relieve symptoms.
While there is abundant information on more conventional treatments for breast cancer, our focus here is on the rationale and available data supporting the use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in these specific cases. It is important to emphasize that evidence regarding the benefit of CRS/HIPEC for these cancers remains limited. Nevertheless, reports suggest potential benefits for certain patients facing breast cancer with rare indications for CRS/HIPEC.
Breast cancer is the second most common cancer in women, after skin cancer. While most cases of breast cancer do not present symptoms, regular mammograms have significantly improved early detection and long-term survival.[see References: 1] Despite this, a significant percentage of cases (~33%) are still diagnosed at later stages,[2] and up to 30% of patients later develop distant metastases, complicating treatment and for which there is no cure.[3] The most common sites of metastasis include the bones, liver, lungs, and brain. Peritoneal metastases (cancer that has spread to the peritoneum from the breast)on the other hand, are rare, affecting <5% of patients,[4-7] and are associated with a worse prognosis, with median survival rates of <6 months.[8, 9]
Breast cancer treatment is highly individualized, tailored to the specific tumor type and stage. Treatment can include surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy, and/or immunotherapy. With such a broad range of treatments, many patients can effectively manage their disease, even after metastasis occurs. However, peritoneal metastases from breast cancer pose a significant challenge. These metastases are rare, cause severe symptoms, and have poor response to chemotherapy and hormonal therapy, leading to a lack of consensus on management. [9-11] Existing literature suggests that most cases are managed with palliative systemic chemotherapy and/or palliative surgery, with poor survival. [12, 13] However, there may be a role for more aggressive treatment strategies, such as cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC), based on its demonstrated benefit in other cancers and promising preliminary data in breast cancer. [13-16]
The evidence supporting the use of CRS with or without HIPEC in breast cancer is extremely limited, with only a few reports available. Several smaller case series have reported survival outcomes after CRS/HIPEC ranging from 13-128 months, indicating that select patients can achieve long-term survival with this approach. [17-19] Additionally, a case series involving 2 patients suggested that CRS/HIPEC may help achieve prolonged control of peritoneal disease. One patient never recurred in the peritoneum, while the other experienced peritoneal recurrence at 26 months after CRS/HIPEC. [20] These findings suggest that CRS/HIPEC may provide extended symptom management and control of intraperitoneal disease, though it remains unclear whether the benefit is due to the surgery alone of the addition of HIPEC.
Other studies have emphasized the importance of achieving complete cytoreduction during CRS for peritoneal metastases from breast cancer. Patients with no residual disease following CRS had a median overall survival of more than 34 months, compared to less than 20 months for those with residual disease (cancer cells that remain after attempts to remove the cancer have been made). [21-23] A multicenter study comparing 20 patients treated with CRS +/- HIPEC and 29 who received palliative treatments (ex. intraperitoneal chemotherapy, palliative surgery, HIPEC or PIPAC for ascites control) found that CRS+/- HIPEC patients had a significantly better overall (median: 61. [5] vs 36 months). This highlights the importance of complete cytoreduction for improved survival, as well as a potential benefit of intraperitoneal chemotherapy for the treatment of peritoneal metastases. [24] However, careful patient selection is crucial and several key prognostic factors that influence outcomes have been identified, including age at diagnosis, the time between breast cancer diagnosis and the development of peritoneal metastases, the presence of extraperitoneal metastases, the ability to achieve a complete cytoreduction, and molecular subtype. [23, 24]
Most patients in these studies had recurrent breast cancer and had already undergone standard treatments. Therefore, CRS with or without HIPEC is largely considered a salvage option for managing peritoneal metastases from breast cancer, given the limited data and small number of patients who qualify for the procedure. In addition to peritoneal metastases, some studies have explored the use of hyperthermic intrathoracic chemotherapy (HITHOC) for lung metastases from breast cancer. These studies found that HITHOC provided symptomatic control of malignant pleural effusions in 59.1% of patients with metastatic breast cancer. [25] Further research is needed to better understand the potential role of these therapies in treating metastatic breast cancer, and they should be considered on a case-by-case basis.
Finding Specialized Care
Finding a care provider who is knowledgeable with colorectal cancer and how to treat it is critically important. To search for providers who specialize in performing CRS/HIPEC and providers who specialize in colorectal cancer, navigate to our Find a Specialist page.​​
Please note: Our goal is to provide information to help you find a doctor closest to your home that can provide the best quality of care for your diagnosis or your anticipated CRS/HIPEC procedure. The Abdominal Cancers Alliance does not endorse any care provider or medical center over another.
Clinical Trials
There are many actively recruiting clinical trials for breast cancer registered online. A full list of all active clinical trials and their current recruitment status can be found on www.ClinicalTrials.gov. Your oncologists (medical, surgical, and radiation) can also help you review clinical trial options and recommendations. However, there are currently no clinical trials for HIPEC in breast cancer, probably due to the rarity of the situation.
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