***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Previous evaluation of our institutional experience with stage IV breast cancer patients with an intact primary tumor ( IPT ) did not reveal an overall survival ( OS ) benefit for surgery at 32.1 months median follow-up . We assessed the impact of surgery after 74.2 months median follow-up , and the effect of systemic therapy and local radiotherapy ( RT ) . Methods We review ed the records of all patients presenting from 1997 to 2002 with stage IV disease with an IPT . Cox proportional hazards modeling was used to assess differences in survival between treatment groups . Results Seventy-four ( 35.6 % ) of 208 patients underwent resection of the IPT . After adjustment for covariates , surgery was associated with improved OS ( p = 0.04 ) . Multivariable analysis revealed that estrogen receptor ( ER ) positivity ( p = 0.002 ) and having only a single focus of metastatic disease ( p = 0.05 ) were also associated with improved OS .  Surgery was highly associated with receipt of RT  ( p = 0.0003 ) . RT was significantly associated with improved survival ( p = 0.015 ) in an exploratory analysis . Conclusions Stage IV breast cancer patients with an IPT treated surgically had significantly improved OS . Radiation to the primary was also associated with improved survival , but this was evident only with adjustment for the effect of surgery . These findings may be limited by selection bias . Completion of ongoing prospect i ve r and omized trials is needed to conclusively determine whether stage IV patients with an IPT should be offered aggressive locoregional therapy The MF07 - 01 trial is a phase III r and omized controlled trial which compares breast cancer patients with distant metastases at presentation who receive locoregional treatment for intact primary tumor with those who do not receive such treatment . The primary objective of the study is to assess whether locoregional treatment of the primary tumor provides a better overall survival . Secondary objectives include progression-free survival , quality -of-life , and morbidity related to locoregional treatment . Locoregional treatments consist of either mastectomy or breast conserving surgery with level I-II axillary clearance in clinical ly or sentinel lymph node positive patients . Radiation therapy to the whole breast follows breast conserving surgery . St and ard systemic therapy is given to all patients either immediately after r and omization in no-locoregional treatment arm or after surgical resection of the intact primary tumor in locoregional treatment arm . The study is conducted in Turkey as a multicenter trial with central r and omization . Total accrual target is 271 . The trial was activated in October 2007 and authorized centers started to recruit patients since then . Clinical Trials.gov identifier number is NCT00557986 
    Output:
    
Based on existing evidence from two r and omised clinical trials , it is not possible to make definitive conclusions on the benefits and risks of breast surgery associated with systemic treatment for women diagnosed with metastatic breast cancer .