Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective"

Transcription

1 Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY th International Congress on the Future of Breast Cancer Coronado, CA 6 August 2011 Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective Monica Morrow MD Chief, Breast Surgery Service Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan-Kettering Cancer Center

2 Why Do Axillary Dissection? Staging Local Control Survival

3 Relapse-free Survival (%) Nodal Treatment and Survival NSABP B Women with Negative Nodes 40 Women with Positive Nodes Fisher B, NEJM 2002;347:567 Years of Follow-up

4 Revisiting Axillary Dissection for SN Positive Patients Pro Smaller cancers, lower nodal disease burden # nodes NOT deciding factor for systemic Rx. Most patients get RT and systemic Rx. Molecular determinants of prognosis, predictors of treatment benefit available Con Local therapy does influence survival.

5 ACOSOG Z0011 A randomized trial of axillary node dissection in women with clinical T1-2 N0 M0 breast cancer who have a positive SN Principal Investigator: Armando E. Giuliano, MD 165 Investigators / 177 Institutions Giuliano A, JAMA 2011;305:589

6 Inclusion/Exclusion Criteria Eligibility Clinical T1 T2 N0 breast cancer H&E-detected metastases in SN (AJCC 5 th edition) Lumpectomy with whole breast irradiation Adjuvant systemic therapy by choice Ineligibility Third field (nodal), irradiation Metastases in SN detected by IHC only Matted nodes 3 or more involved SN

7 Z0011 Study Design Schema

8 Patient and Tumor Characteristics ALND n = 420 Intent-to-treat SLND n = 436 Median age 56 (24-92) 54 (25-90) Clinical T1 68% 71% ER+ 83% 83% PR+ 68% 70% LVI present 41% 36%

9 Patient and Tumor Characteristics Grade ALND n = 420 Intent-to-treat SLND n = % 26% 2 49% 47% 3 29% 28% Histology Ductal 83% 84% Lobular 7% 9% Other 11% 8% Giuliano A, Ann Surg 2010;252:426

10 Adjuvant Systemic Therapy ALND SLND Chemotherapy 57.9% 58.0% Hormonal therapy 46.4% 46.6% Either/Both 96.0% 97.0% P = N.S.

11 Median Number of Lymph Nodes Removed Giuliano ASA Z

12 106 (27.4%) of patients treated with ALND had additional positive nodes removed beyond SN.

13 Number of Positive Lymph Nodes Intent-to-Treat Analysis Giuliano ASA Z

14 Locoregional Recurrence Z11 Median F/u 6.3 yrs ALND n = 420 SN n = 436 Local 15 (3.6%) 8 (1.8%) Regional 2 (0.5%) 4 (0.9%) Total 17 (4.1%) 12 (2.8%) p = 0.11 Giuliano A, Ann Surg 2010;252:426

15 Survival Outcomes Z11 Median F/u 6.3 yrs % DFS % OS SN 83.9 ( %) 92.5 ( %) ALND 82.2 ( %) 91.8 ( %) HR 0.82 ( ) 0.79 ( ) Adjusted HR* 0.88 ( ) 0.87 ( ) Adjusted for age, adjuvant rx Giuliano A, JAMA 2011;305:589

16 Z11: Is it Practice Changing? Yes, but not for: Clinically N+ LABC Mastectomy PBI Neoadjuvant Therapy

17 Top 5 Things Critics Don t Like About Z11 5. Follow-up isn t long enough 4. Not enough ER negatives 3. Not enough young women 2. Failed Study didn t reach accrual goal

18 Time to Nodal Relapse Author Local Rx % ER+ Axillary Recurrence Median Time Fisher, B04 Mastectomy? 14.8 mo Greco BCT mo Martelli BCT mo Fisher B, NEJM 2002;347:567 Greco M, Ann Surg 2000;232:1 Martelli G, Ann Surg Oncol 2011;18:125-33

19 Multivariate Analysis of Regional Nodal Failure Nodal Factors Tumor Factors Rx Factors # Excised T size Nodal RT # Positive LVI Chemotherapy % Positive ER status ECE Margin status Patient Factors Metastasis size Grills IS, IJROBP 2003;56:658 n = 1500 Median F/u 8.1 yrs Rx: BCT, Axillary Dissection ± Nodal RT Age Maximum size nodal mets only significant predictor of regional recurrence.

20 Age and Z11 Regional Recurrence Age < 50 yrs Ax Diss SN n = 2 n = 1

21 Is Z11 a Failed Study? Planned accrual 1900, closed at 891 Slow accrual and low event rate Pre-defined analysis plan carried out Non-inferiority of SN by p =.008 Total LRR, DFS, OS all numerically favor SN group No suggestion of a power problem To reach the 10% LRR threshold suggested by EBCTCG, LRR in the remaining patients in the SN group would need to increase 12x.

22 Survival and Local Control EBCTCG Group 5yr LR 15yr Survival N-, BCS ± RT 16.1% 5.1% N+, BCS ± RT 30.1% 7.1% N+, M ± RT 17.1% 5.4% N-, M ± RT 4.0% -3.6% Z11 ± Ax Diss 0.4% NO CHANCE! Lancet 2005;366:2087 Giuliano A, JAMA 2011;305:589

23 Understanding Z11 Accepting the results of Z11 means recognizing that some patients will have positive nodes which are not removed. There is NO role for nomograms to predict the likelihood of additional positive nodes.

24 Lessons Learned from NSABP B04 Radical Mastectomy n = 362 Total Mastectomy n = 365 Median nodes removed 16 40% positive axillary nodes 18.5% delayed axillary dissection After mastectomy alone, only ½ of patients with involved nodes develop axillary first failure. Fisher B, NEJM 1985;312:674

25 Standard Breast Tangents Treat Some of the Axilla Axillary Level Treated to 95% Prescribed Dose I 79% II 51% III 49% Reznik J, IJROBP 2005;61:163-8

26 Effective Systemic Therapy Contributes to Local Control NSABP B13 ER neg NSABP B14 ER pos No Rx/Placebo 13.4% 14.7% CTX/Tam 2.6% 4.3% NSABP B31 HER2 + N9831 HER2+ CTX 2.8% 2.7% CTX + H 1.7% 1.5% Fisher B, JCO 1996;14:1982 Romand, NEJM 2005;353:1673 Fisher B, JNCI 1996;88:1529

27 Axillary Failure After No Surgery, Tangent RT + Systemic Rx Author n Median f/u (yrs) % Ax Recurrence Martelli * IBCSG ** Veronesi * T1 only ** RT 33% Martelli G, Ann Surg Oncol 2011;18:125 Rudenstam CM, JCO 2006;24:337 Veronesi U, Ann Oncol 2005;16:383

28 ACOSOG Z11 SN only positive node in 70% of cases. 0.9% regional recurrence at 6.3 years completely consistent with other published studies.

29 Why NOT do Axillary Dissection? Morbidity of Axillary Surgery n = 821 SN% ALND % p-value Wound Infection Axillary Paresthesia, 12 mo 9 39 <.0001 Lymphedema, 12 mo Patient Perceived 6 19 <.0001 Measured Lucci A, JCO 2007;25:3657

30 Clinical Implications In clinically node-negative patients undergoing BCT with macrometastases in the SN: - Systemic Rx decision made - ALND not necessary for local control - ALND does not contribute to survival

31 Implementing a Policy of Individualized Axillary Management T3 or N1 Any T,N + mastectomy Receiving neoadjuvant rx Preop documentation of nodal disease with US+FNA avoids SN biopsy. Frozen section to minimize reoperation No IHC for H+E negative nodes.

32 Implementing a Policy of Individualized Axillary Management T1 T2 N0 Undergoing BCT Identification of single abnormal axillary nodes with US + FNA does NOT change management. Cost effectiveness of US to identify extensive axillary disease in cn0 patients requires study. Frozen section of SN no longer routine. Patients 3 involved SN on final pathology returned to OR for axillary dissection.

33 # 1 Thing Critics Don t Like About Z11 Doesn t seem right To cut is to cure (and I get paid for doing it) I m all for progress, it s just change I don t like. Samuel Clemens

Why Do Axillary Dissection? Nodal Treatment and Survival NSABP B04. Revisiting Axillary Dissection for SN Positive Patients

Why 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 information

Implications of ACOSOG Z11 for Clinical Practice: Surgical Perspective

Implications 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 information

Results of the ACOSOG Z0011 Trial

Results 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 information

Radiotherapy Implications of ACOSOG Z-11 for Clinical Practice. Julia White, MD Professor of Radiation Oncology Medical College of Wisconsin

Radiotherapy 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 information

Debate Axillary dissection - con. Prof. Dr. Rodica Anghel Institute of Oncology Bucharest

Debate 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 information

Evaluating 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 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 information

The Role of Sentinel Lymph Node Biopsy and Axillary Dissection

The 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 information

Breast Cancer: Management of the Axilla in Greg McKinnon MD FRCSC SON Vancouver Oct 2016

Breast Cancer: Management of the Axilla in Greg McKinnon MD FRCSC SON Vancouver Oct 2016 Breast Cancer: Management of the Axilla in 2016 Greg McKinnon MD FRCSC SON Vancouver Oct 2016 No Disclosures Principle #1 There is no point talking about surgical therapy in isolation. From a patient

More information

Sentinel Node Biopsy. Is There Any Role for Axillary Dissection? JCCNB Nov 20, Stephen B. Edge, MD

Sentinel Node Biopsy. Is There Any Role for Axillary Dissection? JCCNB Nov 20, Stephen B. Edge, MD Sentinel Node Biopsy Is There Any Role for Axillary Dissection? JCCNB Nov 20, 2010 Tokyo, Japan Stephen B. Edge, MD Roswell Park Cancer Institute University at Buffalo Buffalo, NY USA SNB with Clinically

More information

Radiotherapy 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 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 information

Post-Mastectomy RT after Neoadjuvant Chemotherapy (NAC)

Post-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 information

03/14/2019. Postmastectomy radiotherapy; the meta-analyses, and the paradigm change to altered fractionation Mark Trombetta M.D.

03/14/2019. 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 information

Prophylactic Mastectomy State of the Art

Prophylactic 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 information

M D..,., M. M P.. P H., H, F. F A.. A C..S..

M D..,., M. M P.. P H., H, F. F A.. A C..S.. Implications of NSABP B-32 and Loco-Regional Therapy Considerations After Neoadjuvant Chemotherapy Terry Mamounas, M.D., M.P.H, F.A.C.S. Professor of Surgery Northeastern Ohio Medical University Medical

More information

Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease?

Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease? Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease? Mylin A. Torres, MD Director, Glenn Family Breast Center Louis and Rand Glenn Family Chair in Breast

More information

Evolution of Regional Nodal Management of Breast Cancer

Evolution 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 information

16/09/2015. ACOSOG Z011 changing practice. Presentation outline. Nodal mets #1 prognostic tool. Less surgery no change in oncologic outcomes

16/09/2015. ACOSOG Z011 changing practice. Presentation outline. Nodal mets #1 prognostic tool. Less surgery no change in oncologic outcomes ACOSOG Z011 changing practice The end of axillary US/FNA? Preoperative staging of the axilla in the era of Z011 Adena S Scheer MD MSc FRCSC Surgical Oncologist, St. Michael s Hospital Assistant Professor,

More information

Evolution of Breast Surgery

Evolution of Breast Surgery Evolution of Breast Surgery Natasha Rueth MD Surgical Oncologist Piper Breast Center and Alina Health Surgical Specialists Minneapolis, MN Definitions Radical Mastectomy: Removal of breast, chest muscles,

More information

Neoadjuvant Treatment of. of Radiotherapy

Neoadjuvant 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 information

Surgical Issues in Neoadjuvant Chemotherapy

Surgical Issues in Neoadjuvant Chemotherapy 14 th Bossche Mamma Congress Ruwenbergstraat 7 5271 AG Sint Michielsgestel June 14, 2016 Surgical Issues in Neoadjuvant Chemotherapy Tari A. King MD FACS Chief, Breast Surgery Dana Farber/Brigham and Women

More information

The Challenge of Individualizing Loco-Regional Treatments for Patients with Localized Breast Cancer

The Challenge of Individualizing Loco-Regional Treatments for Patients with Localized Breast Cancer The Challenge of Individualizing Loco-Regional Treatments for Patients with Localized Breast Cancer Le défi des traitements locorégionaux individualisés pour les patientes présentant un cancer du sein

More information

PMRT 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 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 information

Evaluation of the Axilla Post Z-0011 Trial New Paradigm

Evaluation of the Axilla Post Z-0011 Trial New Paradigm Evaluation of the Axilla Post Z-0011 Trial New Paradigm Belinda Curpen, MD, FRCPC; Tetyana Dushenkovska; Mia Skarpathiotakis MD, FRCPC; Carrie Betel, MD, FRCPC; Kalesha Hack, MD, FRCPC; Lara Richmond,

More information

Surgical Considerations in Breast Cancer treated with Neoadjuvant Therapy

Surgical 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 information

Principles of breast radiation therapy

Principles 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 information

ALND. Dr. MJ Vrancken

ALND. Dr. MJ Vrancken ALND Dr. MJ Vrancken ALND in primary surgery se1ng Axillary lymph node dissec8on (ALND) Very nice opera8on; dorsal approach 2 ALND in primary surgery se1ng Axillary lymph node dissec8on (ALND) Very nice

More information

Recent Update in Surgery for the Management of Breast Cancer

Recent Update in Surgery for the Management of Breast Cancer Recent Update in Surgery for the Management of Breast Cancer Wonshik Han, MD, PhD Professor, Department of Surgery, Seoul National University College of Medicine Chief of Breast Care Center, Seoul National

More information

Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer

Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer - Official Statement - Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) for the

More information

EDITORIAL. Ann Surg Oncol (2011) 18: DOI /s

EDITORIAL. Ann Surg Oncol (2011) 18: DOI /s Ann Surg Oncol (2011) 18:2407 2412 DOI 10.1245/s10434-011-1593-7 EDITORIAL Multidisciplinary Considerations in the Implementation of the Findings from the American College of Surgeons Oncology Group (ACOSOG)

More information

Targeting Surgery for Known Axillary Disease. Abigail Caudle, MD Henry Kuerer, MD PhD Dept. Surgical Oncology MD Anderson Cancer Center

Targeting Surgery for Known Axillary Disease. Abigail Caudle, MD Henry Kuerer, MD PhD Dept. Surgical Oncology MD Anderson Cancer Center Targeting Surgery for Known Axillary Disease Abigail Caudle, MD Henry Kuerer, MD PhD Dept. Surgical Oncology MD Anderson Cancer Center Nodal Ultrasound at Diagnosis Whole breast and draining lymphatic

More information

CURRENT CONTROVERSIES IN BREAST CANCER SURGERY Less or more!?

CURRENT CONTROVERSIES IN BREAST CANCER SURGERY Less or more!? CURRENT CONTROVERSIES IN BREAST CANCER SURGERY Less or more!? I have no Disclosures Wolfgang Gatzemeier Breast Unit Milan, Italy 17th ESO-ESMO- EONS Masterclass in Clinical Oncology 24-29 MARCH 2018 Optimal

More information

Breast 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 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 information

Sentinel Lymph Node Biopsy for Breast Cancer

Sentinel Lymph Node Biopsy for Breast Cancer Sentinel Lymph Node Biopsy for Breast Cancer Registrar Tutorial Adam Cichowitz Surgical Registrar The Royal Melbourne Hospital Sentinel Lymph Node Biopsy Axillary LN status important prognostic factor

More information

Surgical Advances in the Treatment of Breast Cancer. Laura Kruper, MD, MSCE Chief, Breast Surgery

Surgical Advances in the Treatment of Breast Cancer. Laura Kruper, MD, MSCE Chief, Breast Surgery Surgical Advances in the Treatment of Breast Cancer Laura Kruper, MD, MSCE Chief, Breast Surgery Nothing to disclose DISCLOSURE LESS IS MORE Radiation Lymph nodes Reconstruction Less is More! Radiation

More information

At many centers in the United States and worldwide,

At many centers in the United States and worldwide, ORIGINAL ARTICLES A Declining Rate of Completion Axillary Dissection in Sentinel Lymph Node-positive Breast Cancer Patients Is Associated With the Use of a Multivariate Nomogram Julia Park, MS, Jane V.

More information

Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift. Edi Brogi MD PhD Attending Pathologist Director of Breast Pathology

Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift. Edi Brogi MD PhD Attending Pathologist Director of Breast Pathology Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift Edi Brogi MD PhD Attending Pathologist Director of Breast Pathology Sentinel Lymph Nodes 2014 AJCC 2010 staging Micrometastases Occult metastases

More information

NSABP Pivotal Breast Cancer Clinical Trials: Historical Perspective, Recent Results and Future Directions

NSABP 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 information

Applicability of the ACOSOG Z0011 Criteria in Women with High-Risk Node-Positive Breast Cancer Undergoing Breast Conserving Surgery

Applicability of the ACOSOG Z0011 Criteria in Women with High-Risk Node-Positive Breast Cancer Undergoing Breast Conserving Surgery Ann Surg Oncol (2015) 22:1128 1132 DOI 10.1245/s10434-014-4090-y ORIGINAL ARTICLE BREAST ONCOLOGY Applicability of the ACOSOG Z0011 Criteria in Women with High-Risk Node-Positive Breast Cancer Undergoing

More information

DOES NEOADJUVANT Rx REALLY DOWN STAGE BR CA? DR KHANYILE DEPARTMENT OF MEDICAL ONCOLOGY, University of Pretoria

DOES NEOADJUVANT Rx REALLY DOWN STAGE BR CA? DR KHANYILE DEPARTMENT OF MEDICAL ONCOLOGY, University of Pretoria DOES NEOADJUVANT Rx REALLY DOWN STAGE BR CA? DR KHANYILE DEPARTMENT OF MEDICAL ONCOLOGY, University of Pretoria BREAST CA STAGING TNM STAGING: - T x N - x - 0-0 - is - 1-1(1mic/1a/1b/1c) - 2(a/b) - 2-3(a/b/c)

More information

2017 Topics. Biology of Breast Cancer. Omission of RT in older women with low-risk features

2017 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 information

Updates on management of the axilla in breast cancer the surgical point of view

Updates on management of the axilla in breast cancer the surgical point of view Updates on management of the axilla in breast cancer the surgical point of view Edwige Bourstyn Centre des maladies du sein Hôpital Saint Louis Paris Sentinel lymph node biopsy (SLNB) is the standard of

More information

Ultrasound or FNA for Predicting Node Positive in Breast Cancer

Ultrasound or FNA for Predicting Node Positive in Breast Cancer Ultrasound or FNA for Predicting Node Positive in Breast Cancer Chiun Sheng Huang, MD, PhD, MPH Professor and Chairman Department of Surgery Director of Breast Care Center National Taiwan University Hospital

More information

Management of the Axilla at Initial Surgery Manejo da Axila em Cirurgia Inicial

Management of the Axilla at Initial Surgery Manejo da Axila em Cirurgia Inicial DISCIPLINA DE MASTOLOGIA ESCOLA PAULISTA DE MEDICINA UNIVERSIDADE FEDERAL DE SÃO PAULO Management of the Axilla at Initial Surgery Manejo da Axila em Cirurgia Inicial Disciplina de Mastologia Prof. Dr.

More information

Advances 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 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 information

How can we Personalize RT as part of Breast-Conserving Therapy?

How 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 information

Page 1. AHN-JHU Breast Cancer Symposium. Novel Local Regional Clinical Trials. Background. Neoadjuvant Chemotherapy Benefit.

Page 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 information

What the surgeon wants from the radiologist before breast cancer surgery. Erica Patocskai Isabelle Trop

What the surgeon wants from the radiologist before breast cancer surgery. Erica Patocskai Isabelle Trop What the surgeon wants from the radiologist before breast cancer surgery Erica Patocskai Isabelle Trop Centre Hospitalier de l université de Montréal CAR, April 2013 Plan What is the role of MRI for breast

More information

What are Adequate Margins of Resection for Breast-Conserving Therapy?

What 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 information

The 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 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 information

Indications 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 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 information

Practice of Axilla Surgery

Practice of Axilla Surgery Summer School of Breast Disease 2016 Practice of Axilla Surgery Axillary Lymph Node Dissection & Sentinel Lymph Node Biopsy 연세의대외과 박세호 Contents Anatomy of the axilla Axillary lymph node dissection (ALND)

More information

Surgical Management of the Axilla

Surgical Management of the Axilla Surgical Management of the Axilla Jean-Francois Boileau, MD, MSc, FRCSC Surgical Oncologist, Montreal Jewish General Hospital Segal Cancer Centre Associate Member, Department of Oncology, McGill University

More information

Surgical Therapy: Sentinel Node Biopsy and Breast Conservation

Surgical 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 information

Case Conference: Post-Mastectomy Radiotherapy

Case Conference: Post-Mastectomy Radiotherapy Case Conference: Post-Mastectomy Radiotherapy Outline - Case Intro Guidelines Studies - Case Conclusion Summary Outline Case Intro to PMRT Guidelines Studies Case conclusion Summary Outline - Case Intro

More information

Loco-Regional Management After Neoadjuvant Chemotherapy

Loco-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 information

ASTRO Refresher Course 2016 Breast Cancer

ASTRO 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 information

Welcome to. American College of Surgeons. Clinical Research Program (ACS-CRP) Breast Surgical Trial Webinar

Welcome to. American College of Surgeons. Clinical Research Program (ACS-CRP) Breast Surgical Trial Webinar American College of Surgeons Clinical Research Program Kelly K. Hunt, M.D. Program Director Welcome to American College of Surgeons Clinical Research Program (ACS-CRP) Breast Surgical Trial Webinar Moderator:

More information

AXILLARY LYMPH NODE DISSECtion

AXILLARY LYMPH NODE DISSECtion ORIGINAL CONTRIBUTION Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis A Randomized Clinical Trial Armando E. Giuliano, MD Kelly K. Hunt,

More information

Lessons Learnt from Neoadjuvant Hormone Therapy. Mike Dixon Clinical Director Breakthrough Research Unit Edinburgh

Lessons Learnt from Neoadjuvant Hormone Therapy. Mike Dixon Clinical Director Breakthrough Research Unit Edinburgh Lessons Learnt from Neoadjuvant Hormone Therapy Mike Dixon Clinical Director Breakthrough Research Unit Edinburgh 10 Lessons Learnt from Neoadjuvant Endocrine Therapy 10 Lessons Learnt from Neoadjuvant

More information

Lessons Learnt from Neoadjuvant Hormone Therapy. 10 Lessons Learnt from Neoadjuvant Endocrine Therapy. Lesson 1

Lessons Learnt from Neoadjuvant Hormone Therapy. 10 Lessons Learnt from Neoadjuvant Endocrine Therapy. Lesson 1 Lessons Learnt from Neoadjuvant Hormone Therapy Mike Dixon Clinical Director Breakthrough Research Unit Edinburgh 10 Lessons Learnt from Neoadjuvant Endocrine Therapy 10 Lessons Learnt from Neoadjuvant

More information

Whole Breast Irradiation: Class vs. Hypofractionation

Whole 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 information

Relevance. Axillary Node Recurrence. Purpose. Case Presentation: Is axillary staging required? Two trends have emerged:

Relevance. Axillary Node Recurrence. Purpose. Case Presentation: Is axillary staging required? Two trends have emerged: Axillary Node Recurrence N.L. Davis Associate Professor of Surgery, UBC Head of Surgical Oncology, BCCA Relevance In an attempt to minimize long term complications and to maximize cancer control, the management

More information

EVALUATION OF AXILLARY LYMPH NODES AFTER NEOADJUVANT SYSTEMIC THERAPY KIM, MIN JUNG SEVERANCE HOSPITAL, YONSEI UNIVERSITY

EVALUATION OF AXILLARY LYMPH NODES AFTER NEOADJUVANT SYSTEMIC THERAPY KIM, MIN JUNG SEVERANCE HOSPITAL, YONSEI UNIVERSITY EVALUATION OF AXILLARY LYMPH NODES AFTER NEOADJUVANT SYSTEMIC THERAPY KIM, MIN JUNG SEVERANCE HOSPITAL, YONSEI UNIVERSITY AXILLARY LYMPH NODE METASTASIS Axillary lymph node metastasis is one of the most

More information

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 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

More information

Surgical Considera0ons with Neoadjuvant Treatment in Breast Cancer

Surgical Considera0ons with Neoadjuvant Treatment in Breast Cancer Surgical Considera0ons with Neoadjuvant Treatment in Breast Cancer David R McCready MD MSc FRCSC FACS GaAuso Chair in Breast Surgical Oncology Professor of Surgery, University of Toronto Princess Margaret

More information

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 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 information

ARROCase - April 2017

ARROCase - April 2017 ARROCase - April 2017 Radiation Indications in the setting of Neoadjuvant chemotherapy for Breast Cancer Lauren Colbert, MD, MSCR Faculty Mentor: Benjamin Smith, MD UT MD Anderson Cancer Center 37 year

More information

Objectives Critically review presentations on 1. Local therapy 2. Adjuvant chemotherapy for isolated local regional recurrence 3. The optimal duration

Objectives Critically review presentations on 1. Local therapy 2. Adjuvant chemotherapy for isolated local regional recurrence 3. The optimal duration Objectives Critically review presentations on 1. Local therapy 2. Adjuvant chemotherapy for isolated local regional recurrence 3. The optimal duration of endocrine therapy 4. Advances in HER2 directed

More information

Surgical Issues in Melanoma

Surgical Issues in Melanoma Surgical Issues in Melanoma Mark B. Faries, MD, FACS Director, Donald L. Morton Melanoma Research Program Director, Surgical Oncology Training Program Professor of Surgery John Wayne Cancer Institute Surgical

More information

Evaluation of Pathologic Response in Breast Cancer Treated with Primary Systemic Therapy

Evaluation of Pathologic Response in Breast Cancer Treated with Primary Systemic Therapy Evaluation of Pathologic Response in Breast Cancer Treated with Primary Systemic Therapy Eun Yoon Cho, MD, PhD Department of Pathology and Translational Genomics Samsung Medical Center Sungkyunkwan University

More information

Spotlights on the surgery role at San Antonio

Spotlights on the surgery role at San Antonio Spotlights on the surgery role at San Antonio Riccardo Masetti, MD Professor of Surgery Director, Multidisciplinary Breast Center Catholic University Rome, Italy Roma, 21 maggio 2017 Prof. Masetti has

More information

Loco-Regional Management After Neoadjuvant Chemotherapy

Loco-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 information

Recent Updates in Surgical Management of Breast Cancer Asian Patient's Perspective

Recent 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 information

When do you need PET/CT or MRI in early breast cancer?

When 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 information

Page 1. AD vs. no AD. Survival. Randomized Trials. All trials reported higher survival in the AD group. Years. Node-NegativeNegative

Page 1. AD vs. no AD. Survival. Randomized Trials. All trials reported higher survival in the AD group. Years. Node-NegativeNegative Sentinel Node Biopsy: The Past, The Present, and The Future Thomas B. Julian, M.D., F.A.C.S. Associate Professor of Human Oncology Drexel University College of Medicine Director of Breast Surgical Oncology

More information

Clinicopathological Factors Affecting Distant Metastasis Following Loco-Regional Recurrence of breast cancer. Cheol Min Kang 2018/04/05

Clinicopathological Factors Affecting Distant Metastasis Following Loco-Regional Recurrence of breast cancer. Cheol Min Kang 2018/04/05 Abstract No.: ABS-0075 Clinicopathological Factors Affecting Distant Metastasis Following Loco-Regional Recurrence of breast cancer 2018/04/05 Cheol Min Kang Department of surgery, University of Ulsan

More information

Breast cancer (screening) in older individuals: the oncologist s viewpoint for the geriatrician

Breast cancer (screening) in older individuals: the oncologist s viewpoint for the geriatrician Breast cancer (screening) in older individuals: the oncologist s viewpoint for the geriatrician Hans Wildiers Medical oncologist, Leuven, Belgium Past chairman of the EORTC elderly task force President-elect

More information

Ines Buccimazza 16 TH UP CONTROVERSIES AND PROBLEMS IN SURGERY SYMPOSIUM

Ines Buccimazza 16 TH UP CONTROVERSIES AND PROBLEMS IN SURGERY SYMPOSIUM BILATERAL MASTECTOMY IS NOT ROUTINELY JUSTIFIED IN PATIENTS WITH BILATERAL AXILLARY LYMPHADENOPATHY AND ONLY ONE DETECTABLE PRIMARY BREAST CANCER LESION SURGERY SYMPOSIUM Ines Buccimazza Breast Unit Department

More information

Only Estrogen receptor positive is not enough to predict the prognosis of breast cancer

Only Estrogen receptor positive is not enough to predict the prognosis of breast cancer Young Investigator Award, Global Breast Cancer Conference 2018 Only Estrogen receptor positive is not enough to predict the prognosis of breast cancer ㅑ Running head: Revisiting estrogen positive tumors

More information

Quando lo svuotamento ascellare in presenza di LS posi5vo? Viviana Galimber5, MD Breast surgery division European Ins5tute of Oncology

Quando lo svuotamento ascellare in presenza di LS posi5vo? Viviana Galimber5, MD Breast surgery division European Ins5tute of Oncology Quando lo svuotamento ascellare in presenza di LS posi5vo? Viviana Galimber5, MD Breast surgery division European Ins5tute of Oncology Randomized clinical trials Sen1nel Node Biopsy Vs Axillary Dissec1on

More information

Invasive Breast Cancer

Invasive Breast Cancer Invasive Breast Cancer Eileen Rakovitch MD MSc FRCPC Sunnybrook Health Sciences Centre Medical Director, Louise Temerty Breast Cancer Centre LC Campbell Chair in Breast Cancer Research Associate Professor,

More information

Extended Hormonal Therapy

Extended 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 information

Intraoperative. Radiotherapy

Intraoperative. Radiotherapy Intraoperative Radiotherapy ROBERTO ORECCHIA UNIVERSITY of MILAN & EUROPEAN INSTITUTE of ONCOLOGY & CNAO FOUNDATION Breast Cancer Brescia, 30th September 2011 IORT, very selective technique to intensify

More information

Radiation Field Design and Regional Control in Sentinel Lymph Node-Positive Breast Cancer Patients With Omission of Axillary Dissection

Radiation Field Design and Regional Control in Sentinel Lymph Node-Positive Breast Cancer Patients With Omission of Axillary Dissection Original Article Radiation Field Design and Regional Control in Sentinel Lymph Node-Positive Breast Cancer Patients With Omission of Axillary Dissection Jeremy Setton, MD 1 ; Hiram Cody, MD 2 ; Lee Tan,

More information

SSO-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 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 information

Emerging Approaches for (Neo)Adjuvant Therapy for ER+ Breast Cancer

Emerging 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 information

THE SURGEON S ROLE: THE AXILLA. Owen A Ung University of Queensland Royal Brisbane and Women s Hospital Wesley and St Andrews Hospital

THE SURGEON S ROLE: THE AXILLA. Owen A Ung University of Queensland Royal Brisbane and Women s Hospital Wesley and St Andrews Hospital THE SURGEON S ROLE: THE AXILLA Owen A Ung University of Queensland Royal Brisbane and Women s Hospital Wesley and St Andrews Hospital What are the concerns with treatment to the axilla Not necessary for

More information

Hypofractionated Radiotherapy for breast cancer: Updated evidence

Hypofractionated 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 information

Is 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 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 information

Surgery for Breast Cancer

Surgery 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 information

Breast cancer: Molecular STAGING classification and testing. Korourian A : AP,CP ; MD,PHD(Molecular medicine)

Breast cancer: Molecular STAGING classification and testing. Korourian A : AP,CP ; MD,PHD(Molecular medicine) Breast cancer: Molecular STAGING classification and testing Korourian A : AP,CP ; MD,PHD(Molecular medicine) Breast Cancer Theory: Halsted Operative breast cancer is a local-regional disease The positive

More information

Should we still be performing IHC on all sentinel nodes?

Should we still be performing IHC on all sentinel nodes? Miami Breast Cancer Conference 31 st Annual Conference March 8, 2014 Should we still be performing IHC on all sentinel nodes? Donald L. Weaver, MD Professor of Pathology University of Vermont USA Miami

More information

RADIOTHERAPY IN BREAST CANCER :

RADIOTHERAPY 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 information

San Antonio Breast Cancer Symposium 2010 Highlights Radiotherapy

San 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 information

Clinical Outcome of Reconstruction With Tissue Expanders for Patients With Breast Cancer and Mastectomy

Clinical Outcome of Reconstruction With Tissue Expanders for Patients With Breast Cancer and Mastectomy Clinical Outcome of Reconstruction With Tissue Expanders for Patients With Breast Cancer and Mastectomy Mitsui Memorial Hospital Department of Breast and Endocine surgery Daisuke Ota No financial support

More information

Radiation 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 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 information

PAPER. Long-term Outcome of Patients Managed With Sentinel Lymph Node Biopsy Alone for Node-Negative Invasive Breast Cancer

PAPER. Long-term Outcome of Patients Managed With Sentinel Lymph Node Biopsy Alone for Node-Negative Invasive Breast Cancer ONLINE FIRST AER Long-term Outcome of atients Managed With Sentinel Lymph Node Biopsy Alone for Node-Negative Invasive Breast Cancer Nimmi S. Kapoor, MD; Myung-Shin Sim, DrH; Jennifer Lin, MD; Armando

More information

Sentinel Node Biopsy and Clinical Decision Making

Sentinel Node Biopsy and Clinical Decision Making Sentinel Node Biopsy and Clinical Decision Making Monica Morrow, M.D. Chairman, Department of Surgical Oncology G. Willing Pepper Chair in Cancer Research The Evolving Role of Axillary Dissection Therapy

More information

8/8/2011. PONDERing the Need to TAILOR Adjuvant Chemotherapy in ER+ Node Positive Breast Cancer. Overview

8/8/2011. 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 information

Neoadjuvant chemotherapy (NACT) in young women with breast cancer. Hanne Melgaard Nielsen, MD Ph.D Department of Oncology, Aarhus University Hospital

Neoadjuvant chemotherapy (NACT) in young women with breast cancer. Hanne Melgaard Nielsen, MD Ph.D Department of Oncology, Aarhus University Hospital Neoadjuvant chemotherapy (NACT) in young women with breast cancer Hanne Melgaard Nielsen, MD Ph.D Department of Oncology, Aarhus University Hospital Young women according to EUSOMA guidelines Is under

More information