Breast Cancer Part 2 Flashcards
Distinct from skin-sparing in that nipple and/or nipple areola complex are conserved
Nipple-Sparing Mastectomy
breast-conserving surgery by wide local excision of the tumor followed by definitive irradiation to the intact breast
Lumpectomy
When the surgical procedure was less than a complete lumpectomy, such as an initial incisional biopsy or core biopsy
When pathologic margins on the initial excisional biopsy are shown to be involved by tumor
When there are residual suspicious microcalcifications on a postlumpectomy mammogram.
Recommendations for re-excision of primary tumor
Modified radical mastectomy may be preferable
for some patients who wish to avoid radiation
for those in whom removal of clinical and radiographically apparent disease will result in a suboptimal cosmetic result
for those with diffusely positive margins which cannot be cleared with re-excision those with diffuse suspicious microcalcifications
personal preference for mastectomy over breast conserving therapy
In Axillary Node Dissection, what are the landmarks for each level of axillary lymph nodes?
Level 1
between axillary vein and latisimuss dorsi
Level 2
between lateral and medial borders of pectoralis minor muscle
Level 3
between medial border of pectoralis minor and Halsted’s ligament
Iwasaki et al.
Identified subgroup of patients who may not undergo axillary lymph node dissection. What are the histologies with lower rates of LN involvement
Medullary, mucinous, and tubular
Although the current standard for patients with a positive sentinel node is to undergo completion axillary dissection, the necessity of this has been questioned and was the subject of this trial which showed:
No significant differences in local recurrence or regional recurrences in SLND and ALND versus ALND alone
What is the name of the trial?
ACOSOG Z0011
What is the conclusion of the ALMANAC trial comparing standard ALND versus Sentinel lymph node dissection with respect to the Primary outcome measure: Arm and shoulder morbidity and QOL
Conclusion: SLNB treatment of choice for patients who have early-stage breast cancer and clinically negative nodes
Most acceptable standard of care for the majority of women with early-stage invasive breast CA
Breast-conserving surgery followed by RT to the intact breast
Journal of National Cancer Institute
Appropriate treatment for Stage I or II breast CA
Preferable because:
Equivalent survival to that of total mastectomy and axillary dissection while preserving the breast
Breast-Conserving Therapy is ideal for?
Unicentric primary tumors and
Relative contraindications for BCT:
Collagen vascular disease Patients with germline mutations that predisposes to breast CA dev’t Positive margins More advanced disease Multicentric disease Pregnancy Prior RT
Based on the NSABP 06 trial,
Disease-free survival among patients in the three cohorts who were treated by total mastectomy, lumpectomy, or lumpectomy and breast irradiation (20yr ff-up). What is the conclusion?
20-year follow-up period – no significant difference in all 3 arms with regards to survival
Remains among the strongest factors for local relapse
Age and margin
What trial showed tamoxifen improved local control rates in pxs with LN (-) breast tumors
NSABP B-21 trial
MD Anderson Cancer Center
use of systemic therapy was the most powerful clinical, pathologic, or treatment predictor of local control, producing a ___-fold reduction in the risk of local recurrence.
3.3
________ is a humanized monoclonal antibody
against the human EGFR-2 (HER2), which is amplified or
overexpressed in about 15% to 20% of invasive breast cancers;
these tumors are known to be more aggressive and more susceptible
to recurrence than HER2-negative tumors
Trastuzumab (Herceptin)
Based on the mature data from the well-conducted randomized trials outlined above and on long-term follow-up from the several large retrospective series, it is apparent that breast-conserving surgery followed by radiation therapy is a safe and effective modality for the majority of women with early-stage invasive breast cancer.
True or false?
True
Collectively, the randomized studies to date consistently demonstrate an approximately threefold greater local relapse rate in the unirradiated
cohorts.
According to Vinh-Hung and Verschraegen in
Meta-analysis of survival and local control in randomized trials comparing breast conserving surgery with or without radiation
What is the conclusion?
Demonstrates a threefold reduction in local relapse and a small but significant increase in survival with the use of radiation therapy following lumpectomy
What is the Benefit of RT in elderly women with early breast CA?
associated with a lower risk of a second ipsilateral breast cancer and subsequent mastectomy
Most likely to benefit
Patients aged 70-79 yrs with minimal comorbidity
Least likely to benefit
Older patients with substantial comorbidity
For women with favorable T1N0, receptor (+) breast CA
Tamoxifen alone is a reasonable option that should be discussed
Patients with low comorbidity and long life expectancy
Offer radiation even in those over age 70 with ER-positive tumor
What is the standard RT technique?
45-50.4 Gy / 1.8-2.0 Gy / Fx (25-28 days )
Followed by 5-8 fraction boost (10-16Gy) for a total of 60-66 Gy
Delivered for 6-7.5 weeks
In the UK Standardization of Breast Radiotherapy (START) - Trial A on the hypofractionated whole breast irradiation concludes ______
Lower total dose in a smaller number of fractions could offer similar rates of tumor control as standard fractionation
Based on ASTRO, the hypofractionated whole breast irradiation likely equivalent to conventional fractionation in patients who meet ALL criteria:
Age over 50 yrs
Pathologic state T1-2N0 treated with lumpectomy
Has not received systemic chemotherapy
Minimum and maximum dose along the central axis is not 107% of the prescription dose
is now the most common method of axillary management in
women with early-stage breast cancer
Sentinel node sampling, with or without full axillary dissection
