Interventional oncology procedures for breast cancer metastatic disease: current role and clinical applications

Worldwide, breast cancer constitutes the most common malignant neoplasm among females, impacting 2.1 million women annually.Interventional oncology techniques have been recently added as an additional therapeutic and palliative alternative in breast cancer metastatic disease, concerning mainly osseous, liver, and lung metastasis.In the current literature, there are reports of promising results and documented efficacy regarding the ablation of liver and lung metastasis from breast carcinoma, transarterial embolization or radioembolization, as well as the treatment of osseous metastatic disease.These literature studies are limited by the heterogeneity of breast cancer disease, the evaluation of variable different parameters, as well as the retrospective nature in most of the cases.Consequently, dedicated prospective series and randomized studies are required to identify the role of minimally invasive local therapies of interventional oncology armamentarium.The present review paper focuses upon the current role of interventional oncology techniques for the curative or palliative treatment of metastatic breast cancer disease.The purpose of this review paper is to present the current minimally invasive procedures in the treatment of metastatic breast disease, including local control rates and survival rates.A ccording to World Health Organization data, globally, breast cancer constitutes the most common malignant neoplasm among female patients, impacting 2.1 million women annually. 1However, in male population breast carcinoma is far less common, affecting 2.620 new patients in the USA during 2020. 2 Predisposing factors include age, genetic mutations (BRCA1 and BRCA2), reproductive history (early menstrual cycles before the age of 12 and menopause after the age of 55), familial history of breast cancer, radiation therapy history, obesity, and smoking. 1,2Specifically for male population additive predisposing factors include Klinefelter syndrome and estrogen therapy. 1,2east cancer is a heterogeneous, complex disease with five main molecular subtypes, defined by the genes the tumor expresses.Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and proliferation marker Ki67 constitute significant biomarkers, which determine the type of the tumor and affect the prognosis.Luminal A type of cancer, in which ER and PR are positive, HER2 is negative, and low levels of Ki-67 are detected, is the most favorable prognosis.However, worst prognosis is encountered in the triple negative breast cancer (ER-, PR-, HER2-), in which there are no targets for approved therapies; therefore, therapeutic armamentarium includes local therapies and/or systemic chemotherapy.Breast cancer is considered a systemic disease, due to the high percentage of patients (>50%) who will develop metastatic disease. 1,2Bone is the commonest site for tumor spread (70%), followed by the lung (50%) and the liver (30%). 3Median survival of patients with metastatic disease from the time of diagnosis is approximately 18-24 months, with 5-and 10-year survival rates being 27% and 13%, respectively. 3Heterogeneity in breast carcinoma also reflects the fact that it is a clonal disease, resulting in metastatic tumors which have different genotype and behavior from the initial tumor.Metastases may present a Darwinian, adaptive type of behavior, and therefore, they constitute highly heterogeneous tumors more resistant to therapy than the initial lesion. 3,4Current treatment options include hormone therapy and targeted therapies (Trastuzumab/Pertuzumab), chemotherapy, surgery, percutaneous and transarterial techniques, radiotherapy, or any combination of the above.