BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO
|
|
- Myles Cummings
- 5 years ago
- Views:
Transcription
1 BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO Chairman Department of Radiation Oncology Albert Einstein Healthcare Network Philadelphia, PA Professor (Adjunct) Temple University Philadelphia, PA Professor Emeritus University of Pennsylvania Philadelphia, PA
2 Radical mastectomy Breast conservation treatment with radiation
3 COMPONENTS OF BREAST CONSERVATION TREATMENT (BCT) 1. Excise the primary tumor 2. Stage the axilla (invasive cancer) 3. Radiation treatment (whole breast) 4. Systemic therapy as indicated
4 ELIGIBILITY FOR BCT Stage: DCIS or clinical T1-2, N0-1 Unicentric disease - Clinical examination - Radiologic imaging Able to excise primary tumor - Negative margins preferred Satisfactory cosmetic outcome Absence of contraindications to BCT
5 CONTRAINDICATIONS TO BCT Absolute Diffuse microcalcifications Gross multicentric disease (GMD) Diffusely positive margins of resection Collagen vascular disease - e.g., SLE, scleroderma - Excluding rheumatoid arthritis Pregnancy (except late pregnancy?) Previous radiation to the breast (?) Relative (cosmetic contraindications) Large tumor-to-breast ratio (neoadjuvant chemo?) Subareolar location of tumor (?)
6 RANDOMIZED TRIALS OF RADIATION AFTER BREAST CONSERVATION SURGERY Whole Breast Fractionation No. of Length reported No. of randomized of follow-up Study trials patients (years) locations Standard Many >10,000 >20 Worldwide BCS/RT vs. mastectomy BCS +/- RT Accelerated Accelerated partial breast irradiation (APBI)
7 RADIATION FRACTIONATION SCHEMAS Fisher C, JCO, 2014
8 LONG TERM OUTCOMES AT 20 YEARS OR MORE AFTER STANDARD (WHOLE BREAST) RADIATION Endpoints Outcome - Local control High - Survival High - Cosmesis High - Complications Low Standard RT remains the gold standard and sets the bar very high for other RT techniques
9 DIRECT RELATIONSHIP OF LOCAL CONTROL TO SURVIVAL: OVERVIEW DATA FOR RANDOMIZED TRIALS OF RADIATION AFTER LUMPECTOMY FOR INVASIVE PRIMARY BREAST CARCINOMA 10-y gain 21.7% Modeling of data: 4 Local recurrences directly lead to 1 avoidable breast cancer death with standard whole breast radiation Overview, Lancet, 2005 Updated data: Local recurrence 25.1% no RT 7.1% with RT 4:1 ratio confirmed Overview, Lancet, 2011
10 DIRECT RELATIONSHIP OF LOCAL CONTROL TO SURVIVAL: OVERVIEW DATA FOR RANDOMIZED TRIALS OF RADIATION AFTER LUMPECTOMY FOR INVASIVE PRIMARY BREAST CARCINOMA Overview, Lancet, :1 Ratio confirmed
11 STANDARD WHOLE BREAST RADIATION TREATMENT
12 BREAST IMRT (INTENSITY MODULATED RT) Standard dose distribution Segmented IMRT Vicini, 2006
13 PROGNOSTIC FACTORS FOR LOCAL CONTROL AFTER BREAST CONSERVATION TREATMENT WITH RADIATION Significant factors for local control Lower risk Higher risk Pathology margins of Negative Positive tumor excision or close Patient age Older Younger Radiation boost dose to Boost No boost the primary tumor site (Higher dose) (Lower dose) Adjuvant systemic therapy Yes No Hormone receptor Positive Negative status Emerging biologic Lower Higher factors risk risk
14 SSO-ASTRO CONSENSUS GUIDELINE ON MARGINS The use of no ink on tumor as the standard for an adequate margin.. is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Moran, JCO, IJROBP, Ann Surg Oncol, 2014
15 LOCAL RECURRENCE (%) 10-YEAR PREDICTED LOCAL RECURRENCE ACCORDING TO MARGIN STATUS AND MINIMUM NEGATIVE MARGIN WIDTH: META-ANALYSIS P =.097 Adjusted test for trend P >.2 Adjusted for endocrine therapy or radiation boost Positive Close Negative % 12% 7% 12% 10% 6% 9% 7% 4% mm 2 mm 5 mm MINIMUM NEGATIVE MARGIN WIDTH Houssami, EJC, 2010
16 ODDS RATIO META-ANALYSIS FOR LOCAL RECURRENCE ACCORDING TO MARGIN WIDTH 1.47 P = 0.12 P = 0.21 (test for trend) 1.0 (reference) Positive vs negative Odds Ratio = 2.44 P <.001 Close vs negative Odds Ratio = 1.74 P <.001 >0 mm vs 5 mm P =.021 MINIMUM NEGATIVE MARGIN WIDTH Houssami, Ann Surg Oncol, 2014
17 EORTC RANDOMIZED TRIAL OF A BOOST AFTER 50 GY WHOLE BREAST RADIATION IN 5,318 PATIENTS Bartelink, JCO, 2007
18 EORTC RANDOMIZED TRIAL OF A BOOST AFTER 50 GY WHOLE BREAST RADIATION IN 5,318 PATIENTS Age groups Interaction of age with boost Bartelink, JCO, 2007
19 LOCAL FAILURE ACCORDING TO BIOLOGIC FACTORS AFTER BREAST CONSERVATION TREATMENT WITH RADIATION ER/PR Neg Pos (Hormones) Solin, Clinical Breast Cancer, 2009 Yang, Breast Cancer Res Treat, 2008 Neg Pos (Hormones) p =.047 Nguyen, JCO, 2008 Haffty, IJROBP, 2008
20 Local Regional Failure at 10 Years (%) LOCAL-REGIONAL FAILURE ACCORDING TO 21-GENE RECURRENCE SCORE ASSAY AFTER BREAST CONSERVATION TREATMENT 40 NSABP B14 AND B20 ECOG E Age < 50 P =.057 Age 50 P =.66 Age < 50 P =.09 Age 50 P = Recurrence Score Mamounas, JCO, 2010 Solin, BCRT, 2012
21 Cumulative Incidence Rate LRR in Patients with Lumpectomy + Breast XRT in NSABP B Positive Nodes (N=336) >4 Positive Nodes (N=125) RS Low RS Intermediate RS High P-value = 0.12 N LRR Events % 6.2% 3.9% RS Low RS Intermediate RS High P-value = N LRR Events % 12.8% 0.0% Time in Years Time in Years
22 CONTRALATERAL BREAST CANCER (%) META-ANALYSIS OF LOCAL FAILURE ACCORDING TO THE USE OF BREAST MRI STUDY DCIS or Invasive Breast Carcinoma No difference: BCT vs mastectomy Use of RT All P >.2 Houssami, JCO, Breast MRI No breast MRI No. Subset pts P value P =.39 DCIS YEARS 6% 6% Invasive CA Solin, JCO, 2008
23 POTENTIAL ADVERSE CONSEQUENCES OF BREAST MRI Breast MRI Odds Yes No ratio P value Delay to surgery Bleicher, days.011 Hulvat, days 32 days.054 Landercasper, days 8 days.001 Krishnan, days 27 days <.001 Increased use of (ipsilateral) mastectomy Houssami, % (1%)* Turnbull, COMICE, % (2%)* 1% Pengel, % 0% Katipamula, % 36% 1.7 <.0001 Bleicher, % 20% Sorbero, Hulvat, Increased use of contralateral prophylactic mastectomy Sorbero, % 4.7% *Pathologically avoidable
24 IS THERE A GROUP OF PATIENTS FOR WHOM RADIATION CAN BE OMITTED? NSABP B-21 Fisher, JCO 2002
25 EVALUATION OF RADIATION BENEFIT IN FAVORABLE SUBSETS OF PATIENTS: RANDOMIZED TRIALS OR SEER DATA Consider comorbidity, life expectancy Fyles, EBCC, 2010 T1-2, N0 Age > 50 years 8.5% better at 10 years SEER, Smith B, JNCI, 2006 T1 N0, Age > 70 years, ER positive Underpowered for survival, other endpoints T1 N0, Age > 70 years, ER positive 4.6% better at 10 years Hughes, JCO, % better at 10 years T1, Age > 70 years, ER positive Kunkler, SABCS, % better at 5 years p =.001 T1-2 (up to 3cm) Age > 65 years, ER positive
26 DCIS: MANAGEMENT OPTIONS Local - Lumpectomy plus radiation - Lumpectomy alone - Mastectomy Systemic - Tamoxifen Optimal treatment strategy is unknown!
27 RATIONALE FOR RADIATION TREATMENT AFTER LUMPECTOMY FOR DCIS All five randomized trials show that radiation reduces the rate of local recurrence after lumpectomy, generally by about half Retrospective, institutional studies of lumpectomy alone are hypothesis generating, not hypothesis testing [P]atients who may avoid radiation therapy have not been reproducibly and reliably identified by any clinical trials. (1999 DCIS Consensus Conference Statement, Cancer, 2000)
28 Oxford Overview of Randomized Trials of BCS±RT for DCIS Study Entry Women randomised Median followup Surgery* Negative margins required % with boost Data available: NSABP B y WLE (37% ad) Yes 9% EORTC y WLE (20% ad) Yes 5% Swedish BCCG y Sect res (17% ad) No 2% UK/ANZ DCIS y WLE (No ad) Yes NR Data unavailable: RTOG N/A WLE (No ad) Yes NR * WLE: wide local excision; ad: axillary dissection; Sect res: sector resection 2x2 factorial design: ±RT±Tam Boost not recommended Some patients still taking tamoxifen Median follow-up for all trials with data available: 8.9 y Darby, JNCI Monograph, 2010
29 Ips. BREAST RECURRENCE (Inv only) (%) BREAST CANCER MORTALITY (%) Oxford Overview of Randomized Trials of BCS±RT for DCIS DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) 3723 women 5-year gain 10.5 % (SE 1.2) 10-year gain 15.2 % (SE 1.6) logrank 2p < DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (Inv only) 3723 women 5-year gain 5.4 % (SE 0.8) 10-year gain 8.5 % (SE 1.3) logrank 2p < DCIS: BCS + RT vs. BCS BREAST CANCER MORTALITY 3726 women 5-year loss 0.4 % (SE 0.4) 10-year loss 0.5 % (SE 0.8) logrank 2p > 0.1; NS BCS 28.1% BCS 15.4% BCS+RT 12.9% Years since randomisation 17:41:28 9 Sep 2009 Provisional results: subject to revision (Name: gr_cis_sc_rt_rlili_all_0) BCS+RT 6.8% Years since randomisation 17:42:03 9 Sep 2009 Provisional results: subject to revision (Name: gr_cis_sc_rt_rlilii_all_0) BCS+RT 4.1% BCS 0 3.7% Years since randomisation 17:46:08 9 Sep 2009 Provisional results: subject to revision (Name: gr_cis_sc_rt_bcdth_all_0) Darby, JNCI Monograph, 2010
30 EBCTCG Overview of Randomized Trials of BCS±RT for DCIS Patient Subset Identified A Priori As Potentially At Low Risk: Low Nuclear Grade, Negative Margins, Path Tumor Size < 20 mm Darby, JNCI Monograph, 2010
31 EXCISION PLUS RADIATION FOR DCIS: RESULTS FROM INTERNATIONAL COLLABORATIVE STUDY (n = 1,003) Solin, Cancer, 2005
32 MULTIDISCIPLINARY MANAGEMENT OF DCIS: NSAPB B-17 AND B-24 All IBTR Invasive IBTR Wapnir, ASCO, 2007
33 RETROSPECTIVE SELECTION CRITERIA FOR TREATMENT WITH LUMPECTOMY ALONE AND NO RADIATION Study Criteria Lagios, 1982 Mammo detection, neg. margins, grade I-II Lagios, 1989 Mammo detection, neg. margins, grade I-II, size <2.5 cm Schwartz, 1992 Mammo detection or incidental finding, neg. margins, size <2.5 cm, (?noncomedo) Silverstein, 1992 Patient refusal of radiation treatment Silverstein, 1995 Grade I-II + necrosis Silverstein, 1996 Van Nuys Prognostic Index (VNPI) score 3-4 Silverstein, 1999 Negative margin width >10 mm Silverstein, 2002 Modified VNPI score 4-6 Silverstein, 2010 Modified VNPI score 4-6 or score 7 margins >3 mm NCCN, 2014 Low risk Not otherwise defined
34 RESULTS OF LUMPECTOMY ALONE (NO RADIATION) FOR DCIS No. of Actuarial local recurrence (%) patients At 5 yrs At 10 yrs At 15 yrs Retrospective Arnesson Blamey * Cataliotti Cutuli * Hughes 60 18* Lagios 79 15* 20* 22 Schwartz * 41* 49* Silverstein Saunders 28 12* 19* 32* Prospective NSABP B * 30* -- EORTC * Swedish * 30* -- JCRT study ECOG 5194 Low/int grade High grade RTOG *Estimated from curve
35 12-GENE DCIS SCORE: ECOG E5194 DCIS Score (0 100) evaluated 2 ways: - Continuous variable - 3 prespecified risk groups: Low, Intermediate, High Solin, JNCI, 2013
36 10-YEAR LOCAL RECURRENCE ACCORDING TO DCIS SCORE: ECOG E5194 VALIDATION DATA ANY IBE INVASIVE IBE Example of patient with DCIS Score = 20 Solin, JNCI, 2013
37 DCIS SCORE: SECOND INDEPENDENT VALIDATION STUDY Rakovitch E, Oral Abstract, SABCS, December, 2014: A large prospectively-designed study of the DCIS Score
38 SUMMARY OF RANDOMIZED TRIALS FOR DCIS Lumpectomy and RT tamoxifen vs. anastrozole NSABP B-35 Lumpectomy and RT + trastuzumab (if Her2 +) NSABP B-43 Conventional whole breast RT vs. Accelerated partial breast irradiation (APBI) NSABP/RTOG Whole breast radiation + boost BIG 3-07
39 SUMMARY Early stage invasive carcinoma Local control matters About 1 in 4 local failures results in a preventable breast cancer death 20-year survival after BCT equal to mastectomy Margins of resection are important DCIS Good long term outcome for BCT/Radiation Radiation and tamoxifen (ER +) reduce risk Molecular profiling and biologic subtyping Evolving strategy for improved risk assessment and tailored local-regional treatment
BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO
BREAST CONSERVATION TREATMENT IN EARLY STAGE DISEASE AND DCIS LAWRENCE J. SOLIN, MD, FACR, FASTRO Chairman Department of Radiation Oncology Albert Einstein Medical Center Philadelphia, PA Professor (Adjunct)
More informationRadiation and DCIS. The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging
Radiation and DCIS The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging Einsley-Marie Janowski, MD, PhD Assistant Professor Department of Radiation Oncology
More informationBruno CUTULI Policlinico Courlancy REIMS. WORKSHOP SULL IRRADIAZIONE MAMMARIA IPOFRAZIONATA Il carcinoma duttale in situ
Bruno CUTULI Policlinico Courlancy REIMS WORKSHOP SULL IRRADIAZIONE MAMMARIA IPOFRAZIONATA Il carcinoma duttale in situ XXI CONGRESSO AIRO GENOVA 22.11.2011 INTRODUCTION Due to wide diffusion of mammography,
More informationRadiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy. Julia White MD Professor, Radiation Oncology
Radiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy Julia White MD Professor, Radiation Oncology Agenda Efficacy of radiotherapy in the management of breast cancer in the Adjuvant
More informationSpeaker s Bureau. Travel expenses. Advisory Boards. Stock. Genentech Invuity Medtronic Pacira. Faxitron. Dune TransMed7 Genomic Health.
Management of DCIS Shawna C. Willey, MD, FACS Professor of Surgery, Georgetown University Director, Medstar Regional Breast Health Program Chief, Department of Surgery Medstar Georgetown University Hospital
More informationBalancing Evidence and Clinical Practice in the Treatment of Localized Breast Cancer May 5, 2006
Balancing Evidence and Clinical Practice in the Treatment of Localized Breast Cancer May 5, 2006 Deborah Hamolsky MS, RN : DCIS Carol Franc Buck Breast Care Center UCSF Comprehensive Cancer Center Jane
More informationWhat are Adequate Margins of Resection for Breast-Conserving Therapy?
What are Adequate Margins of Resection for Breast-Conserving Therapy? Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School What are Adequate Margins
More informationDisclosures. Premalignant Lesions of the Breast: What Clinicians Want and Why. NY Times: Prone to Error: Earliest Steps to Find Cancer.
Disclosures Premalignant Lesions of the Breast: What Clinicians Want and Why I have nothing to disclose Rick Baehner, MD Assistant Professor, UCSF Pathology NY Times: Prone to Error: Earliest Steps to
More informationSan Antonio Breast Cancer Symposium 2010 Highlights Radiotherapy
San Antonio Breast Cancer Symposium 2010 Highlights Radiotherapy Kathleen C. Horst, M.D. Assistant Professor Department of Radiation Oncology Stanford University The Optimal SEquencing of Adjuvant Chemotherapy
More informationDisclosure. Objectives 03/19/2019. Current Issues in Management of DCIS Radiation Oncology Considerations
Current Issues in Management of DCIS Radiation Oncology Considerations Fariba Asrari, M.D. Director. Johns Hopkins Breast Center at Green Spring Station Department of Radiation Oncology & Molecular Sciences
More informationGenomic Profiling of Tumors and Loco-Regional Recurrence
1 Genomic Profiling of Tumors and Loco-Regional Recurrence Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,
More informationEarly Stage Breast Cancer
Local-Regional Management of Early Stage Breast Cancer Meena S. Moran, MD Associate Professor, Yale University School of Medicine Disclosure I have no conflicts of interest to disclose. Learning Objectives
More informationWhole Breast Irradiation: Class vs. Hypofractionation
Whole Breast Irradiation: Class vs. Hypofractionation Kyung Hwan Shin, MD, PhD. Dept. of Radiation Oncology, Seoul National University Hospital 2018. 4. 6. GBCC Treatment Trends of Early Breast Cancer
More informationIORT What We ve Learned So Far
IORT What We ve Learned So Far The 16 th Annual Conference on A Multidisciplinary Approach to Comprehensive Breast Care and Imaging Einsley-Marie Janowski, MD, PhD Assistant Professor Department of Radiation
More informationConsensus Guideline on Accelerated Partial Breast Irradiation
Consensus Guideline on Accelerated Partial Breast Irradiation Purpose: To outline the use of accelerated partial breast irradiation (APBI) for the treatment of breast cancer. Associated ASBS Guidelines
More informationState of the Art in 2000 State of the Art today Gazing forward
2010 Buschke Lecture: The Relationship between Local Recurrence and Survival in Breast Cancer Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School
More informationCurrent Status of Accelerated Partial Breast Irradiation. Julia White MD Professor, Radiation Oncology
Current Status of Accelerated Partial Breast Irradiation Julia White MD Professor, Radiation Oncology I have no disclosures relative to the presented material Agenda ABPI Timeline APBI by Method Clinical
More informationSSO-ASTRO Consensus Guidance Margins for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer
SSO-ASTRO Consensus Guidance Margins for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer Dr. Yvonne Tsang St. Paul s Hospital Introductions Breast-conserving
More informationHow can we Personalize RT as part of Breast-Conserving Therapy?
How can we Personalize RT as part of Breast-Conserving Therapy? Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School Disclosures I have no COI disclosures
More information03/14/2019. Postmastectomy radiotherapy; the meta-analyses, and the paradigm change to altered fractionation Mark Trombetta M.D.
radiotherapy; the meta-analyses, and the paradigm change to altered fractionation Mark Trombetta M.D. Division of Radiation Oncology Allegheny Health Network Cancer Institute Professor of Radiation Oncology
More informationWhen do you need PET/CT or MRI in early breast cancer?
When do you need PET/CT or MRI in early breast cancer? Elizabeth A. Morris MD FACR Chief, Breast Imaging Service Memorial Sloan-Kettering Cancer Center NY, NY Objectives What is the role of MRI in initial
More informationDCIS: Margins and the USC/VNPI
DCIS: Margins and the USC/VNPI Van Nuys USC Hoag Melvin J. Silverstein, M.D Gross Endowed Chair in Oncoplastic Surgery Director, Hoag Breast Program Newport Beach, CA Clinical Professor of Surgery Keck
More informationDuctal Carcinoma In Situ: Review of the Role of Radiation Therapy and Current Controversies
Ductal Carcinoma In Situ: Review of the Role of Radiation Therapy and Current Controversies Frank Vicini, MD, FACR, and Chirag Shah, MD Abstract Despite a lack of randomized trials comparing breast-conserving
More informationNeoadjuvant Treatment of. of Radiotherapy
Neoadjuvant Treatment of Breast Cancer: Role of Radiotherapy Neoadjuvant Chemotherapy Many new questions for radiation oncology? lack of path stage to guide indications should treatment response affect
More information2017 Topics. Biology of Breast Cancer. Omission of RT in older women with low-risk features
2017 Topics Biology of Breast Cancer Early-stage HER2+ breast cancer-can we avoid RT? Prediction tools for locoregional recurrence Omission of RT in older women with low-risk features Local-Regional Recurrence
More informationACCELERATED BREAST IRRADIATION EVOLVING PARADIGM FOR TREATMENT OF EARLY STAGE BREAST CANCER
ACCELERATED BREAST IRRADIATION EVOLVING PARADIGM FOR TREATMENT OF EARLY STAGE BREAST CANCER KHANH NGUYEN, MD, MA DEPARTMENT OF RADIATION ONCOLOGY BAYHEALTH CANCER CENTER BREAST CANCER STATISTICS Most common
More informationLoco-Regional Management After Neoadjuvant Chemotherapy
1 Loco-Regional Management After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,
More informationLoco-Regional Management After Neoadjuvant Chemotherapy
1 Loco-Regional Management After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health Cancer Center at Orlando Health Professor of Surgery,
More informationPrinciples of breast radiation therapy
ANZ 1601/BIG 16-02 EXPERT ESMO Preceptorship Program 2017 Principles of breast radiation therapy Boon H Chua Professor Director of Cancer and Haematology Services UNSW Sydney and Prince of Wales Hospital
More informationPMRT for N1 breast cancer :CONS. Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center
PMRT for N1 breast cancer :CONS Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center DBCG 82 b & c Overgaard et al Radiot Oncol 2007 1152 pln(+), 8 or more nodes removed Systemic
More informationWhat is an Adequate Lumpectomy Margin in 2018?
What is an Adequate Lumpectomy Margin in 2018? Stuart J. Schnitt, M.D. Brigham and Women s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School Boston, MA None Disclosures Topics Current
More informationImplications of ACOSOG Z11 for Clinical Practice: Surgical Perspective
:$;7)#*8'-87*4BCD'E7)F'31$4.$&'G$H'E7)F&'GE'>??ID >?,"'@4,$)4*,#74*8'!74/)$++'74',"$'A.,.)$'7%'()$*+,'!*42$)!7)74*67&'!3 6 August 2011 Implications of ACOSOG Z11 for Clinical
More informationBreast Surgery When Less is More and More is Less. E MacIntosh, MD June 6, 2015
Breast Surgery When Less is More and More is Less E MacIntosh, MD June 6, 2015 Presenter Disclosure Faculty: E. MacIntosh Relationships with commercial interests: None Mitigating Potential Bias Not applicable
More informationCa in situ e ormonoterapia. Discussant : LORENZA MARINO
Ca in situ e ormonoterapia Discussant : LORENZA MARINO Ca in situ e ormonoterapia Quali fattori di rischio? Radioterapia? Ormonoterapia? BCS Recurrence rates (FUP 13-20y) Cuzick, Lancet Oncol.2011; 12(1):
More informationPartial Breast Irradiation for Breast Conserving Therapy
To Radiate or Not? Is APBI the Right Compromise Solution? Partial Breast Irradiation for Breast Conserving Therapy Julia White MD Professor, Radiation Oncology Agenda Role of radiotherapy in breast conservation
More informationNSABP Pivotal Breast Cancer Clinical Trials: Historical Perspective, Recent Results and Future Directions
1 1 NSABP Pivotal Breast Cancer Clinical Trials: Historical Perspective, Recent Results and Future Directions Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program UF Health
More informationWhy Do Axillary Dissection? Nodal Treatment and Survival NSABP B04. Revisiting Axillary Dissection for SN Positive Patients
Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 10th International Congress on the Future of Breast Cancer Coronado, CA Why Do Axillary Dissection? 6 August 2011 Implications
More informationBreast Cancer Earlier Disease. Stefan Aebi Luzerner Kantonsspital
Breast Cancer Earlier Disease Stefan Aebi Luzerner Kantonsspital stefan.aebi@onkologie.ch Switzerland Breast Cancer Earlier Disease Diagnosis and Prognosis Local Therapy Surgery Radiation therapy Adjuvant
More informationImplications of ACOSOG Z11 for Clinical Practice: Surgical Perspective
Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 10th International Congress on the Future of Breast Cancer Coronado, CA 6 August 2011 Implications of ACOSOG Z11 for Clinical
More information2017 San Antonio Breast Cancer Symposium: Local Therapy Highlights
2017 San Antonio Breast Cancer Symposium: Local Therapy Highlights Mylin A. Torres, M.D. Director, Glenn Family Breast Center Associate Professor Department of Radiation Oncology Winship Cancer Institute
More informationAngela Gilliam, MD University of Colorado Surgical Grand Rounds November 3, 2008
Angela Gilliam, MD University of Colorado Surgical Grand Rounds November 3, 2008 Breast Cancer Most common cancer in American women 180,000 new cases per year Second most common cause of cancer death 44,000
More informationBreast Cancer. Dr. Andres Wiernik 2017
Breast Cancer Dr. Andres Wiernik 2017 Agenda: The Facts! (Epidemiology/Risk Factors) Biological Classification/Phenotypes of Breast Cancer Treatment approach Local Systemic Agenda: The Facts! (Epidemiology/Risk
More informationRADIOTHERAPY IN BREAST CANCER :
RADIOTHERAPY IN BREAST CANCER : PAST, PRESENT, FUTURE Dr Jyotirup Goswami Consultant Radiation Oncologist Narayana Cancer Institute Narayana Superspecialty Hospital Breast cancer is the classic paradigm
More informationRecent Updates in Surgical Management of Breast Cancer Asian Patient's Perspective
Recent Updates in Surgical Management of Breast Cancer Asian Patient's Perspective Tokyo-West Tokushukai Hospital Department of Breast Oncology Tokyo-West Tokushukai Hospital, Tokyo, Japan Kaz Sato, MD,
More informationIs Breast Radiation Therapy Necessary in the Elderly? Cancer and Leukemia Group B Radiation Therapy Oncology Group Eastern Cooperative Oncology Group
Is Breast Radiation Therapy Necessary in the Elderly? Cancer and Leukemia Group B Radiation Therapy Oncology Group Eastern Cooperative Oncology Group CALGB 9343 Submitted 1990 Opened July 15, 1994 Closed
More informationThe Management of Breast Cancer 2015 ASTRO Spring Refresher
The Management of Breast Cancer 2015 ASTRO Spring Refresher Gary M. Freedman, M.D. Associate Professor Disclosure I have no conflicts of interest to disclose. 2 Learning Objectives Apply knowledge of randomized
More informationResults of the ACOSOG Z0011 Trial
DCIS and Early Breast Cancer Symposium JUNE 15-17 2012 CAPPADOCIA Results of the ACOSOG Z0011 Trial Kelly K. Hunt, M.D. Professor of Surgery Axillary Node Dissection Staging, Regional control, Survival
More informationDuctal Carcinoma-in-Situ: New Concepts and Controversies
Ductal Carcinoma-in-Situ: New Concepts and Controversies James J. Stark, MD, FACP Medical Director, Cancer Program and Palliative Care Maryview Medical Center Professor of Medicine, EVMS Case Presentation
More informationPost-Mastectomy RT after Neoadjuvant Chemotherapy (NAC)
Post-Mastectomy RT after Neoadjuvant Chemotherapy (NAC) Jay R. Harris, M.D. Dana-Farber Cancer Institute Brigham and Women s Hospital Harvard Medical School Conclusions When considering PMRT, use both
More informationDebate Axillary dissection - con. Prof. Dr. Rodica Anghel Institute of Oncology Bucharest
Debate Axillary dissection - con Prof. Dr. Rodica Anghel Institute of Oncology Bucharest Summer School of Oncology, third edition Updated Oncology 2015: State of the Art News & Challenging Topics Bucharest,
More informationHypofractionated Radiotherapy for breast cancer: Updated evidence
2 rd Bangladesh Breast Cancer Conference, Dhaka, December 2017 Hypofractionated Radiotherapy for breast cancer: Updated evidence Tabassum Wadasadawala Associate Professor of Radiation Oncology Tata Memorial
More informationA DEEPER DIVE INTO DUCTAL CARCINOMA IN SITU: CLINICAL AND PATHOLOGIC CONSIDERATIONS IN 2015
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 A DEEPER DIVE INTO DUCTAL CARCINOMA IN SITU: CLINICAL AND PATHOLOGIC CONSIDERATIONS IN 2015
More informationSurgical Considerations in Breast Cancer treated with Neoadjuvant Therapy
Surgical Considerations in Breast Cancer treated with Neoadjuvant Therapy Rebecca Warburton MD Department of Surgery, University of British Columbia Mount Saint Joseph Hospital, Providence Health Care
More informationASTRO Refresher Course 2016 Breast Cancer
ASTRO Refresher Course 2016 Breast Cancer Jennifer R. Bellon, M.D. Dana-Farber Cancer Institute Associate Professor of Radiation Oncology Harvard Medical School I have no relevant conflicts of interest
More informationObjectives Intraoperative Radiation Therapy for Early Stage Breast Cancer
Objectives Intraoperative Radiation Therapy for Early Stage Breast Cancer Cristina Lopez-Peñalver, MD, FACS October 11, 2014 Disclosures I have no relevant commercial relationships to disclose. Discuss
More informationResection Margins in Breast Conserving Surgery. Alberto Costa, MD Canton Ticino Breast Unit Lugano, Switzerland
Resection Margins in Breast Conserving Surgery Alberto Costa, MD Canton Ticino Breast Unit Lugano, Switzerland Breast Conserving Surgery 1 Probably one of the most important innovation in cancer surgery
More informationWilliam J. Gradishar MD
Northwestern University Feinberg School of Medicine Adjuvant Endocrine Therapy For Postmenopausal Women SOBO 2013 William J. Gradishar MD Betsy Bramsen Professor of Breast Oncology Director, Maggie Daley
More informationProphylactic Mastectomy State of the Art
Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 6 th Brazilian Breast Cancer Conference Sao Paulo, Brazil 9 March 2012 Prophylactic Mastectomy State of the Art Monica Morrow
More informationORMONOTERAPIA ADIUVANTE: QUALE LA DURATA OTTIMALE? MARIANTONIETTA COLOZZA
ORMONOTERAPIA ADIUVANTE: QUALE LA DURATA OTTIMALE? MARIANTONIETTA COLOZZA THE NATURAL HISTORY OF HORMONE RECEPTOR- POSITIVE BREAST CANCER IS VERY LONG Recurrence hazard rate 0.3 0.2 0.1 0 ER+ (n=2,257)
More informationExtended Hormonal Therapy
Extended Hormonal Therapy Dr. Caroline Lohrisch, Medical Oncologist, BC Cancer Agency Vancouver Centre November 1, 2014 www.fpon.ca Optimal Endocrine Therapy for Women with Hormone Receptor Positive Early
More informationIndications and Technical Considerations for Adjuvant Radiation after Neoadjuvant Chemotherapy in Breast Cancer
Indications and Technical Considerations for Adjuvant Radiation after Neoadjuvant Chemotherapy in Breast Cancer Wendy A. Woodward, M.D. Ph.D. A sociate Profesor Section Chief, Breast Radiation Oncology
More informationProtocol of Radiotherapy for Breast Cancer
107 年 12 月修訂 Protocol of Radiotherapy for Breast Cancer Indication of radiotherapy Indications for Post-Mastectomy Radiotherapy (1) Axillary lymph node 4 positive (2) Axillary lymph node 1-3 positive:
More informationRadiotherapy Implications of ACOSOG Z-11 for Clinical Practice. Julia White, MD Professor of Radiation Oncology Medical College of Wisconsin
1 Radiotherapy Implications of ACOSOG Z-11 for Clinical Practice Julia White, MD Professor of Radiation Oncology Medical College of Wisconsin Disclosures: none Agenda 1. ACOSOG Z-11: Another perspective
More informationEmerging Approaches for (Neo)Adjuvant Therapy for ER+ Breast Cancer
Emerging Approaches for (Neo)Adjuvant Therapy for E+ Breast Cancer Cynthia X. Ma, M.D., Ph.D. Associate Professor of Medicine Washington University in St. Louis Outline Current status of adjuvant endocrine
More informationAhmad Elahi*, Gholamreza Toogeh,Habibollah Mahmoodzadeh, Behnaz Jahanbin, Farhad Shahi,
Clinical Experience Open Access DOI: 10.1187/abc.20185258-62 Ductal Carcinoma In Situ Close to the Inked Margin: A Case Presented in Multidisciplinary Session With Clinical Discussion and Decision Making
More informationClinical Outcomes of Ductal Carcinoma In Situ of the Breast Treated with Partial Mastectomy without Adjuvant Radiotherapy
Original Article http://dx.doi.org/10.3349/ymj.2012.53.3.537 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 53(3):537-542, 2012 Clinical Outcomes of Ductal Carcinoma In Situ of the Breast Treated with
More informationSurgical Therapy: Sentinel Node Biopsy and Breast Conservation
Surgical Therapy: Sentinel Node Biopsy and Breast Conservation Stephen B. Edge, MD Professor of Surgery and Oncology Roswell Park Cancer Institute University at Buffalo Dr. Roswell Park: Tradition in Cancer
More informationPage 1. AHN-JHU Breast Cancer Symposium. Novel Local Regional Clinical Trials. Background. Neoadjuvant Chemotherapy Benefit.
AHN-JHU Breast Cancer Symposium Novel Local Regional Clinical Trials March 22, 2019 Thomas B. Julian, MD, FACS Associate Medical Director, Cancer Program Development, ANH Cancer Institute Background In
More informationBreast Surgery: Yesterday, Today and Tomorrow
Breast Surgery: Yesterday, Today and Tomorrow Baptist Hospital Gladys L. Giron, MD, FACS October 11,2014 Homestead Hospital Baptist Children s Hospital Doctors Hospital Baptist Cardiac & Vascular Institute
More informationdoi: /j.ijrobp
doi:10.1016/j.ijrobp.2009.12.047 Int. J. Radiation Oncology Biol. Phys., Vol. 79, No. 4, pp. 977 984, 2011 Copyright Ó 2011 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ see front matter
More informationThe Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.
Society of Surgical Oncology American Society for Radiation Oncology American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole- Breast Irradiation in
More informationPRACTICE GUIDELINE FOR BREAST CONSERVATION THERAPY IN THE MANAGEMENT OF INVASIVE BREAST CARCINOMA
The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College
More informationBreast Cancer. Most common cancer among women in the US. 2nd leading cause of death in women. Mortality rates though have declined
Breast Cancer Most common cancer among women in the US 2nd leading cause of death in women Mortality rates though have declined 1 in 8 women will develop breast cancer Breast Cancer Breast cancer increases
More informationBreast Cancer. Saima Saeed MD
Breast Cancer Saima Saeed MD Breast Cancer Most common cancer among women in the US 2nd leading cause of death in women 1 in 8 women will develop breast cancer Incidence/mortality rates have declined Breast
More informationConsiderations in Adjuvant Chemotherapy. Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology
Considerations in Adjuvant Chemotherapy Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology 80 70 60 50 40 30 20 10 0 EBCTCG 2005/6 Overview Control Arms with No Systemic Treatment
More informationThe Neoadjuvant Model as a Translational Tool for Drug and Biomarker Development in Breast Cancer
The Neoadjuvant Model as a Translational Tool for Drug and Biomarker Development in Breast Cancer Laura Spring, MD Breast Medical Oncology Massachusetts General Hospital Primary Mentor: Dr. Aditya Bardia
More informationSurgery for Breast Cancer
Surgery for Breast Cancer 1750 Mastectomy - Petit 1894 Radical mastectomy Halsted Extended, Super radical mastectomy 1948 Modified radical mastectomy Patey 1950-60 WLE & RT Baclesse, Mustakallio 1981-85
More informationUK Interdisciplinary Breast Cancer Symposium. Should lobular phenotype be considered when deciding treatment? Michael J Kerin
UK Interdisciplinary Breast Cancer Symposium Should lobular phenotype be considered when deciding treatment? Michael J Kerin Professor of Surgery National University of Ireland, Galway and Galway University
More informationCorporate Medical Policy
Corporate Medical Policy Breast Brachytherapy for Accelerated Partial Breast Radiotherapy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: breast_brachytherapy_for_accelerated_partial_breast_radiotherapy
More informationPersonalized Treatment of DCIS
Global Breast Cancer Conference 2016 [The Shilla Hotel, Jeju] Symposium 1 : DCIS - What s New? (14:40-15:50) Personalized Treatment of DCIS 2016. 4. 28. Breast Division, Department of Surgery Sungkyunkwan
More informationDuctal Carcinoma in Situ (DCIS)
Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Ductal Carcinoma in Situ (DCIS) Ductal Carcinoma in Situ DCIS Versions 2002 2017: Audretsch / Blohmer / Brunnert / Budach /
More informationRadiation Therapy for the Oncologist in Breast Cancer
REVIEW ARTICLE Chonnam National University Medical School Sung-Ja Ahn, M.D. Adjuvant Tamoxifen with or without in Patients 70 Years of Age with Stage I ER-Positive Breast Cancer: Efficacy Outcomes (10
More informationThe Role of Sentinel Lymph Node Biopsy and Axillary Dissection
The Role of Sentinel Lymph Node Biopsy and Axillary Dissection Henry Mark Kuerer, MD, PhD, FACS Department of Surgical Oncology University of Texas MD Anderson Cancer Center SLN Biopsy Revolutionized surgical
More informationThe Role of Pathologic Complete Response (pcr) as a Surrogate Marker for Outcomes in Breast Cancer: Where Are We Now?
1 The Role of Pathologic Complete Response (pcr) as a Surrogate Marker for Outcomes in Breast Cancer: Where Are We Now? Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program
More informationEvolution of Regional Nodal Management of Breast Cancer
Evolution of Regional Nodal Management of Breast Cancer Bruce G. Haffty, MD Director (Interim) Rutgers Cancer Institute of New Jersey Professor and Chair Department of Radiation Oncology Rutgers, The State
More informationConservative Surgery and Radiation Stage I and II Breast Cancer
Conservative Surgery and Radiation Stage I and II Breast Cancer Variant 1: Premenopausal 41-year-old woman, 1.1-cm GII IDC, upper outer quadrant (UOQ), ER/PR ( ), HER2 ( ), primary excised with lumpectomy,
More informationBREAST MRI. Elizabeth A. Rafferty, M.D. Avon Comprehensive Breast Center Massachusetts General Hospital Harvard Medical School
BREAST MRI Elizabeth A. Rafferty, M.D. Avon Comprehensive Breast Center Massachusetts General Hospital Harvard Medical School BREAST MRI Any assessment of the breast parenchyma requires the administration
More information8/8/2011. PONDERing the Need to TAILOR Adjuvant Chemotherapy in ER+ Node Positive Breast Cancer. Overview
Overview PONDERing the Need to TAILOR Adjuvant in ER+ Node Positive Breast Cancer Jennifer K. Litton, M.D. Assistant Professor The University of Texas M. D. Anderson Cancer Center Using multigene assay
More informationReview Article Role of the Radiotherapy Boost on Local Control in Ductal Carcinoma In Situ
International Surgical Oncology Volume 2012, Article ID 748196, 5 pages doi:10.1155/2012/748196 Review Article Role of the Radiotherapy Boost on Local Control in Ductal Carcinoma In Situ Olivier Riou,
More information259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up
Breast Cancer Res Treat (2008) 109:405 416 DOI 10.1007/s10549-007-9668-7 REVIEW 259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow
More informationReview Article Ductal Carcinoma In Situ: What Can We Learn from Clinical Trials?
International Surgical Oncology Volume 2012, Article ID 296829, 7 pages doi:10.1155/2012/296829 Review Article Ductal Carcinoma In Situ: What Can We Learn from Clinical Trials? Lucio Fortunato, 1 Igor
More informationAccelerated Partial Breast Irradiation
Accelerated Partial Breast Irradiation OSCO/OU Stephenson Cancer Center Saturday, March 5, 2016 Robert Kuske, MD, FAACE Founder, Medical Director Arizona Breast Cancer Specialists Scottsdale, Arizona 1
More informationEvolving Insights into Adjuvant Chemotherapy. Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology
Evolving Insights into Adjuvant Chemotherapy Joyce O Shaughnessy, MD Baylor Sammons Cancer Center Texas Oncology US Oncology 80 70 60 50 40 30 20 10 0 EBCTCG 2005/6 Overview Control Arms with No Systemic
More informationEvaluating the Z011 study and how local-regional therapy for early breast cancer may change
Evaluating the Z011 study and how local-regional therapy for early breast cancer may change Karen Hoffman, M.D., M.H.Sc., M.P.H. Dept of Radiation Oncology The University of Texas MD Anderson Cancer Center
More informationRecurrence, new primary and bilateral breast cancer. José Palacios Calvo Servicio de Anatomía Patológica
Recurrence, new primary and bilateral breast cancer José Palacios Calvo Servicio de Anatomía Patológica Ipsilateral Breast Tumor Relapse (IBTR) IBTR can occur in approximately 5 20% of women after breast-conserving
More informationINVASIVE BREAST CANCER CURRENT ISSUES IN RADIATION
INVASIVE BREAST CANCER CURRENT ISSUES IN RADIATION Bruce G. Haffty, MD Professor and Chairman Dept Radiation Oncology UMDNJ-RWJMS Cancer Institute of New Jersey Mastectomy vs BCS +RT BCS Without Radiation
More information10 reasons why it makes sense to rename DCIS to minimise overtreatment? PRO: Mike Dixon OBE Edinburgh Breast Unit
10 reasons why it makes sense to rename DCIS to minimise overtreatment? PRO: Mike Dixon OBE Edinburgh Breast Unit 10 reasons why it makes sense to rename DCIS to minimise overtreatment? PRO: Mike Dixon
More informationPartial Breast Irradiation using adaptive MRgRT
Partial Breast Irradiation using adaptive MRgRT Shyama Tetar, radiation-oncologist VUmc Amsterdam 15-12-2017 5 th Vumc SBRT symposium 2017 Current practice Breast conserving treatment (BCT) Breast conserving
More informationAdvances in Breast Surgery. Catherine Campo, D.O. Breast Surgeon Meridian Health System April 17, 2015
Advances in Breast Surgery Catherine Campo, D.O. Breast Surgeon Meridian Health System April 17, 2015 Objectives Understand the surgical treatment of breast cancer Be able to determine when a lumpectomy
More informationThe Role of a Boost Radiation Dose in Patients with Negative Re-Excision Findings
24 The Open Breast Cancer Journal, 2011, 3, 24-28 Open Access The Role of a Boost Radiation Dose in with Negative Re-Excision Melanie C. Smitt and Kathleen C. Horst * Department of Radiation Oncology,
More information