Are there situations where it's appropriate to offer postmastectomy radiation therapy to patients with biopsy-proven M1 disease?

The two randomized studies evaluating benefit of local treatment for stage IV breast cancer at diagnosis were negative for the end point of improving survival. One from Turkey which randomized patients to upfront local treatment vs. none showed a trend for improved survival for bone only disease on subset analysis, although negative for all. One from Mumbai started with chemo first and patients who responded were randomized to local treatment or not and that was negative. The problem with the Mu...

Short answer -- I agree with the answers above and think we have no good data to answer this question.

Long answer -- For now, I divide patients into two groups:

1) Those patients with "oligometastatic disease" who we have decided to treat with a curative paradigm (e.g., a solitary sternal metastasis): I prefer PMRT and aggressive treatment of the site(s) of metastatic disease. If eligible, enrollment on NRG BR002 would be ideal.

2) All other patients with metastatic disease: It is not clear to ...

There are two situations when it should be considered:

1. After ablative treatment of a solitary met.

2. Known gross residual disease after neo-adjuvant chemo with clearance of mets.