Breast Flashcards
What kind of biopsy is always needed in breast
core biopsy for architectural assessment
Management for ADH found at biopsy
Excisional biopsy, you may find DCIS
Management of LCIS at biopsy
excisional biopsy, if no ivasive ca or DCIS, no def tx necessary. If pleomorphic moreso
ipsi lung constraint for hypofrac breast
V16< 15%, V8 < 40%
contralateral lung constraint for hypofrac breast
V4<10%
heart constraint for hypofrac breast RT
V16<5%, V8<30%, mean < 3.2 Gy (4)
How deep is the max dose of a given electron energy
1/4 of the energy
What depth gets 80% of the dose with a given electron energy
1/3 of the energy
apbi 30 in 5 lung constraint
V10Gy<15%
apbi 30 in 5 heart constraint
V2 Gy < 5%, Max 5 Gy
tamoxifen MOA
it’s a SERM, binds to estrogen receptor and blocks estrogen binding, 20 mg qd x 5 years
MOA of anastrazole
aromatase inhibitor
Pre-menopausal hormone therapy
tamoxifen
post-menopausal hormone therapy
anastrazole
contraindications to BCT
multicentric, diffuse suspicious microcalcs, persistent + margins, pregnant
oncotype cutoff for women<50
16
oncotype cutoff for women>50
26
pertuzumab is only given in what setting
neoadj
what is ddAC-T
Doxo, cyclo, paclitaxel, 60, 600, 80 (doxo cyclo q2w x4) Tx12 q1wk
TCHP
trastuzumab, pertuzumab, carbo, docetaxel
inferior border of scv field
bottom of clavicular head
Comprehensive breast lung constraint
V20<25%, V10<65%
Comprehensive breast heart constraint
V25<5%, Mean < 4 Gy, V25<2% for right sided
When is PMRT controversial
N1a and T3N0
if doing neoadj chemo for cytoreduction, what should you do first
SLNB
indications for adj RT after neoadj chemo
cN2+ initially, ypN+, positive margins, lECE, possibly ypN0 if initially N+
Do you still do RT after pCR at mastectomy
Yeah for cIII patients
who gets additional adjuvant chemo?
TNBC gets xeloda, Herceptin for Her2+
Who doesn’t get postmastectomy XRT
T1-3N0, T1-2 if only 1-3 LNs, unless they have other risk factors
When do you boost after mastectomy
close or postiive margins only
workup for IBC
CBC, CMP, alk phos, mammogram, PET/CT, biopsy
What is the keynote regimen?
Carboplatin, paclitaxel, pembro, then additional four cycles of pembro and doxorubicin-cyclophosphamide.
