gms | German Medical Science

Background: Stage dependent primary breast cancer (BC) potentially disseminates building metastases although local treatment is sufficient. Disseminated tumour cells (DC) beforeprimary treatment must be postulated, being the seed for metastases if their ability to proliferate is induced or not suppressed. Adjuvant treatment strategies aim on these DC trying to bring them to apoptosis. Several laboratories focus their work on detection of DC in bone marrow (BM) aspiration samples. With advanced laboratory techniques including magneto beadenrichment and immunocytochemistry DC can be detected in BM in more than 90 % of patients (pts) with primary BC undergoing first surgery as a proof for the model of a primary local disease with early systemical dissemination. Therefore examination on DC in BM may offer a prognostic tool if performed when adjuvant chemotherapy and irradiation is finished at about 6 to 9 months after surgery. If DC are detected immunocytochemistry is able to analyse oestrogen(E) receptor (R), progesterone (P) R, EGF-R, Her2new R and proliferation markers. Sequential adjuvant treatmentcan bebased on these results.

Methods: From 1995, May to 2004, August BM examination for DC was performed in 243 following pts with primary adjuvant BC 6 to 9 months after surgery with finished adjuvant chemotherapy and irradiation. If DC was detected analysis on ER, PR, Her2new and EGF-R followed. Her2new negative hormone R positive pts received tamoxifen, Her2new positive hormone R positive ptsreceived aromatase inhibitors, Her2new positive hormone R negative pts received HerceptinÒ and EGF-R positive pts received bisphosphonates. Hormone, Her2new and EGF-R negative DC did not influence treatment. BM was re-examined every 12 months until negative for DC. DC negative pts were treated according to recent St. Gallen recommendations. DC positive and negative pts were followed up for disease free (DFS) and over al survival (OS).

Results: 164/243 pts (67%) were DC positive in BM, 79 pts (33%) were negative. All pts were stratified according to there initial stage of BC regarding TMN status, ER/PR status, Her2new status and menopausal status. Sequential adjuvant treatment was adapted to the BM results in all pts. Median follow up was 48 months. In the DC positive group DFS and OS after 1 year was 163/164 and 164/164, after 3 years 132/139 and 133/139,, respectively. In the DC negative group DFS and OS after 1 year was 79/79 and 79/79, after 3 years 65/67 and 66/67,respectively.

Conclusions: DC negative BM seems to predict a good clinical outcome in BC pts. Pts DC positivein BM may benefit from immunocytochemistry adapted sequential adjuvant treatment.

Analysing methods for examination of DC in BM should include magneto beadaccumulation and immunocytochemistry.A consensus in these techniques is necessary forcomparable examinations and controlled studies to further investigate this strategy.