Ablative procedures in patients with metastatic breast carcinoma

The ability to determine the content of sex steroid receptors in breast carcinoma cells has markedly enhanced the clinician's ability to predict the response to hormonal therapy in patients with metastatic breast carcinoma. Formerly the surgical ablation of endocrine organs (hypophysectomy, adrenalectomy, and oophorectomy) was used as the initial therapy in many patients with metastatic breast carcinoma. Currently, however, only oophorectomy is employed as the initial treatment of choice in patients with recurrent breast carcinoma, and its use is exclusively limited to premenopausal or perimenopausal patients whose tumors are estrogen-receptor positive. The decreased utilization of surgical ablative procedures is primarily due to the introduction into clinical practice of two pharmacologic agents, the antiestrogen, tamoxifen, and the adrenal blocking agent, aminoglutethimide. When administered to postmenopausal patients with metastatic breast carcinoma, these pharmacologic agents induce remissions as frequently as do surgical ablative procedures; however, their use is associated with distinctly less morbidity and virtually no mortality.