A re-evaluation of the place of major extirpation in the management of patients with metastatic mammary carcinoma.

Clearly defined indications for major extirpation procedures in metastatic mammary carcinoma are lacking. A reassessment of experience with 222 patients (133 after adrenalectomies and 89 after hypophysectomies) was therefore undertaken. This experience has changed our previous opinions that such procedures should be used only at the end of a sequential program of treatment.It is now felt that extirpation is only contraindicated in menopausal women with a duration of disease less than two years or when there is symptomatic disease of vital organs. Otherwise, early extirpation is recommended. When vital organ involvement is recognized in the asymptomatic stage or when screening of premenopausal women by castration indicates continuing hormonal dependency, then early extirpation is indicated.Both the qualitative and the quantitative responses achieved exceed those obtained by other measures when widely disseminated disease is present. The objective remission rate (34% after adrenalectomy and 19% after hypophysectomy) for longer than six months is worth while.