Invasive breast cancer Flashcards
Mastectomy versus breast conservation therapy (BCT)- which is better?
For early stage node negative disease- Both are equivalent.
High dose RT to chest wall- Can we do BCT
No
Diffuse malignant-appearing calcifications on mamography- Can we do BCT
No
Multifocal or multicentric disease- can we do BCT
No
Positive margin- can we do BCT
No
Relative contraindication to BCT
- Active connective tissue disease involving skin
- Tumor > 5cm
- Focally positive margin
- Known or suspected BRCA mutation.
can RT be omitted for age > 70 y patient
Yes- CALGB 9343 showed that age>70 + Tumor <2cm + Clinically node negative disease, Tamoxifen only was not inferior to breast specific survival.
What happens to loco-regional treatment rates with neoadjuvant chemo
Mastectomy rates go down by 17% (NSABP B-18)
Local regional recurrence - what to do
Mastectomy and ALND is not done previously.
Give RT if not given previously.
When to give Chemo in loco-regional recurrence
Hormone negative recurrence- do surgery and then given chemotherapy.
Who get post mastectomy radiation
- Node positive disease- for sure (>4 node positive), N3 disease, T3N0, Tumor < 5cm but close margin (<1mm)
- Strongly consider 1-3 positive lymph node.
Axillary node dissection- sentinel versus complete dissection
NSABP B32- ALND following SLND in SLN negative patient did not improve survival
SLND alone is safe and effective in clinically node negative patient
Do all positive SLN positive patient need dissection, who are clinically node negative?
Z-11 trial- Positive SLN (ALND or not)
- Good histology patient in their 50’s
- No difference in survival or local recurrence rate.
Not for patients who are
- Clinically node positive
- Who got neoadjuvant chemo
- Mastectomy and recurring in nodes.
- Partial or prone breast irradiation.
