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

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

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

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

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

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

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

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

Early Stage Breast Cancer

Early 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 information

What is Cancer? Petra Ketterl, MD Medical Oncology and Functional Medicine

What is Cancer? Petra Ketterl, MD Medical Oncology and Functional Medicine What is Cancer? Petra Ketterl, MD Medical Oncology and Functional Medicine What is Cancer? Layman s terms: cancer starts when cells grow out of control (in any place in the body) and crowd out normal cells

More information

Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery

Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery Breast Cancer Res Treat (2016) 160:387 391 DOI 10.1007/s10549-016-4017-3 EDITORIAL Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery Monika Brzezinska 1 Linda J.

More information

DCIS: Margins and the USC/VNPI

DCIS: 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 information

Balancing 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 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 information

Minesh Mehta, Northwestern University. Chicago, IL

Minesh Mehta, Northwestern University. Chicago, IL * Minesh Mehta, Northwestern University Chicago, IL Consultant: Adnexus, Bayer, Merck, Tomotherapy Stock Options: Colby, Pharmacyclics, Procertus, Stemina, Tomotherapy Board of Directors: Pharmacyclics

More information

Role of Genomic Profiling in (Minimally) Node Positive Breast Cancer

Role of Genomic Profiling in (Minimally) Node Positive Breast Cancer Role of Genomic Profiling in (Minimally) Node Positive Breast Cancer Kathy S. Albain, MD, FACP Professor of Medicine Dean s Scholar Loyola University Chicago Stritch School of Medicine Cardinal Bernardin

More information

TAILORx: Established and Potential Implications for Clinical Practice

TAILORx: Established and Potential Implications for Clinical Practice TAILORx: Established and Potential Implications for Clinical Practice Joseph A. Sparano, MD Study Chair, TAILORx Vice-Chair, ECOG-ACRIN Cancer Research Group Hello Healthcare Summit Berlin, Germany March

More information

Clinical Case Conference Melanoma

Clinical Case Conference Melanoma Clinical Case Conference Melanoma Epidemiology ~60,000 cases and 8,000 deaths per year in US Caucasian:African American = 10:1 15% arise from existing nevi 91% are cutaneous 15% are LN+ at presentation

More information

Introduction. Approximately 20% of invasive breast cancers

Introduction. Approximately 20% of invasive breast cancers Introduction Approximately 2% of invasive breast cancers overexpress HER2 The current standard of care for neoadjuvant therapy is dual-targeted therapy with trastuzumab and pertuzumab plus chemotherapy

More information

Radioterapia dopo svuotamento ascellare: quando? Radiotherapy after axillary dissection: when?

Radioterapia dopo svuotamento ascellare: quando? Radiotherapy after axillary dissection: when? Radioterapia dopo svuotamento ascellare: quando? Radiotherapy after axillary dissection: when? Elisabetta Perrucci SC Radioterapia Oncologica Azienda Ospedaliera di Perugia Post-operative Node RT High-risk

More information

Anthracyclines for Breast Cancer? Are Adjuvant Anthracyclines Dispensible? Needs to be Answered in a Large Prospective Trial

Anthracyclines for Breast Cancer? Are Adjuvant Anthracyclines Dispensible? Needs to be Answered in a Large Prospective Trial Anthracyclines for Breast Cancer? Are Adjuvant Anthracyclines Dispensible? Needs to be Answered in a Large Prospective Trial Joanne L. Blum, MD, PhD Baylor-Sammons Cancer Dallas, TX Early Breast Cancer

More information

Tumor characteristics of breast cancer in predicting axillary lymph node metastasis

Tumor characteristics of breast cancer in predicting axillary lymph node metastasis e-issn 1643-3750 DOI: 10.12659/MSM.890491 Received: 2014.02.05 Accepted: 2014.04.01 Published: 2014.07.07 Tumor characteristics of breast cancer in predicting axillary lymph node metastasis Authors Contribution:

More information

RADIOTHERAPY FOR STAGE II AND STAGE III BREAST CANCER PATIENTS WITH NEGATIVE LYMPH NODES AFTER PREOPERATIVE CHEMOTHERAPY AND MASTECTOMY

RADIOTHERAPY FOR STAGE II AND STAGE III BREAST CANCER PATIENTS WITH NEGATIVE LYMPH NODES AFTER PREOPERATIVE CHEMOTHERAPY AND MASTECTOMY doi:10.1016/j.ijrobp.2010.12.054 Int. J. Radiation Oncology Biol. Phys., Vol. 82, No. 1, pp. e1 e7, 2012 Copyright Ó 2012 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ - see front matter

More information

Debate: Adjuvant vs. Neoadjuvant Therapy for Urothelial Cancer

Debate: Adjuvant vs. Neoadjuvant Therapy for Urothelial Cancer Debate: Adjuvant vs. Neoadjuvant Therapy for Urothelial Cancer Kala Sridhar, MD, MSc, FRCPC Medical Oncologist, Princess Margaret Hospital GU Medical Oncology Site Group Head Associate Professor, University

More information

Recurrence, 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 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 information

Breast-Conserving Therapy for Triple-Negative Breast Cancer

Breast-Conserving Therapy for Triple-Negative Breast Cancer Research Original Investigation PACIFIC COAST SURGICAL ASSOCIATION Breast-Conserving Therapy for Triple-Negative Breast Cancer Alexandra Gangi, MD; Alice Chung, MD; James Mirocha, MS; Douglas Z. Liou,

More information

Follow-up Care of Breast Cancer Patients

Follow-up Care of Breast Cancer Patients Follow-up Care of Breast Cancer Patients Dr. Simon D. Baxter, MD, FRCPC Medical Oncologist BC Cancer Kelowna Clinical Instructor, Dept of Medicine University of British Columbia 19 April 2018 Disclosures

More information

Rationale For & Design of TAILORx. Joseph A. Sparano, MD Albert Einstein College of Medicine Montefiore-Einstein Cancer Center Bronx, New York

Rationale For & Design of TAILORx. Joseph A. Sparano, MD Albert Einstein College of Medicine Montefiore-Einstein Cancer Center Bronx, New York Rationale For & Design of TAILORx Joseph A. Sparano, MD Albert Einstein College of Medicine Montefiore-Einstein Cancer Center Bronx, New York Declining Breast Cancer Mortality & Event Rates in Adjuvant

More information

Sentinel Node Biopsy: Not for everyone!

Sentinel Node Biopsy: Not for everyone! Sentinel Node Biopsy: Not for everyone! Janeen Jordan, MD PGY6 October 6, 2008 Overview Why SN Prognosis Survival Therapy Breast Skin Colorectal Other Complications Hematoma Seroma

More information

Triple Negative Breast cancer New treatment options arenowhere?

Triple Negative Breast cancer New treatment options arenowhere? Triple Negative Breast cancer New treatment options arenowhere? Ofer Rotem, M.D., B.Sc. Breast Unit, Davidoff center Rabin Medical center October 2017 Case 6/2013 - M.D., 38 years old woman, healthy, no

More information

Reliable Evaluation of Prognostic & Predictive Genomic Tests

Reliable Evaluation of Prognostic & Predictive Genomic Tests Reliable Evaluation of Prognostic & Predictive Genomic Tests Richard Simon, D.Sc. Chief, Biometric Research Branch National Cancer Institute http://brb.nci.nih.gov Different Kinds of Biomarkers Prognostic

More information

Citation Hong Kong Practitioner, 1996, v. 18 n. 2, p

Citation Hong Kong Practitioner, 1996, v. 18 n. 2, p Title Conservative surgery for breast cancer Author(s) Poon, RTP; Chow, LWC; Au, GKH Citation Hong Kong Practitioner, 1996, v. 18 n. 2, p. 68-72 Issued Date 1996 URL http://hdl.handle.net/722/45367 Rights

More information

STAGE CATEGORY DEFINITIONS

STAGE CATEGORY DEFINITIONS CLINICAL Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery TX Tis Tis (DCIS) Tis (LCIS) Tis (Paget s) T1 T1mi T1a T1b T1c a b c

More information

Certified Breast Care Nurse (CBCN ) Test Content Outline (Effective 2018)

Certified Breast Care Nurse (CBCN ) Test Content Outline (Effective 2018) Certified Breast Care Nurse (CBCN ) Test Content Outline (Effective 2018) I. Coordination of Care - 26% A. Breast health, screening, early detection, risk assessment and reduction 1. Issues related to

More information

Ca in situ e ormonoterapia. Discussant : LORENZA MARINO

Ca 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 information

Bringing the Fight to Cancer Annual Report

Bringing the Fight to Cancer Annual Report Bringing the Fight to Cancer. 216 Annual Report Quality Study Adherence to Adjuvant System Therapy Following Primary Surgery in Stage II Breast Cancer Patients: Baylor Scott & White Medical Center Irving

More information

Donna Plecha, MD 1, Shiyu Bai, BS 2, Helen Patterson 3, Cheryl Thompson, PhD 4, and Robert Shenk, MD 5

Donna Plecha, MD 1, Shiyu Bai, BS 2, Helen Patterson 3, Cheryl Thompson, PhD 4, and Robert Shenk, MD 5 Ann Surg Oncol DOI 10.1245/s10434-015-4527-y ORIGINAL ARTICLE BREAST ONCOLOGY Improving the Accuracy of Axillary Lymph Node Surgery in Breast Cancer with Ultrasound-Guided Wire Localization of Biopsy Proven

More information

METASTASES OF PATIENTS WITH EARLY STAGES OF BREAST CANCER

METASTASES OF PATIENTS WITH EARLY STAGES OF BREAST CANCER Trakia Journal of Sciences, No 4, pp 7-76, 205 Copyright 205 Trakia University Available online at: http://www.uni-sz.bg ISSN 33-7050 (print) doi:0.5547/tjs.205.04.02 ISSN 33-355 (online) Original Contribution

More information

Kathy Albain, MD. Chemotherapy in Luminal Breast Cancer: Who Benefits? Loyola University Chicago Stritch School of Medicine

Kathy Albain, MD. Chemotherapy in Luminal Breast Cancer: Who Benefits? Loyola University Chicago Stritch School of Medicine Chemotherapy in Luminal Breast Cancer: Who Benefits? Kathy Albain, MD Loyola University Chicago Stritch School of Medicine, Director, Breast Clinical Research Program, Cardinal Bernardin Cancer Center,

More information

ACCELERATED BREAST IRRADIATION EVOLVING PARADIGM FOR TREATMENT OF EARLY STAGE BREAST CANCER

ACCELERATED 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 information

Impact of BMI on pathologic complete response (pcr) following neo adjuvant chemotherapy (NAC) for locally advanced breast cancer

Impact of BMI on pathologic complete response (pcr) following neo adjuvant chemotherapy (NAC) for locally advanced breast cancer Impact of BMI on pathologic complete response (pcr) following neo adjuvant chemotherapy (NAC) for locally advanced breast cancer Rachna Raman, MD, MS Fellow physician University of Iowa hospitals and clinics

More information

Implications of Progesterone Receptor Status for the Biology and Prognosis of Breast Cancers

Implications of Progesterone Receptor Status for the Biology and Prognosis of Breast Cancers 日大医誌 75 (1): 10 15 (2016) 10 Original Article Implications of Progesterone Receptor Status for the Biology and Prognosis of Breast Cancers Naotaka Uchida 1), Yasuki Matsui 1), Takeshi Notsu 1) and Manabu

More information

Completing the Puzzle AJCC TNM Staging Breast. Nicole Catlett, CTR 2017 Kentucky Cancer Registry Fall Conference, September 21 & 22, 2017

Completing the Puzzle AJCC TNM Staging Breast. Nicole Catlett, CTR 2017 Kentucky Cancer Registry Fall Conference, September 21 & 22, 2017 Completing the Puzzle AJCC TNM Staging Breast Nicole Catlett, CTR 2017 Kentucky Cancer Registry Fall Conference, September 21 & 22, 2017 OBJECTIVES Understanding of Breast TNM staging Identify clinical

More information

Locoregional Outcomes in Clinical Stage IIB Breast Cancer After Neoadjuvant Therapy and Mastectomy With or Without Radiation

Locoregional Outcomes in Clinical Stage IIB Breast Cancer After Neoadjuvant Therapy and Mastectomy With or Without Radiation Locoregional Outcomes in Clinical Stage IIB Breast Cancer After Neoadjuvant Therapy and Mastectomy With or Without Radiation Dayssy A. Diaz, MD, Judith Hurley, MD, Isildinha Reis, PhD, Cristiane Takita,

More information

Session thématisée Les Innovations diagnostiques en cancérologie

Session thématisée Les Innovations diagnostiques en cancérologie 10 èmes Journées Scientifiques du Cancéropôle Nord-Ouest 10-12 mai 2017, Deauville Session thématisée Les Innovations diagnostiques en cancérologie Les signatures multigéniques pronostiques dans le cancer

More information

Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care Hormone Sensitive Breast Cancer February 9, 2016

Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care Hormone Sensitive Breast Cancer February 9, 2016 Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care Hormone Sensitive Breast Cancer February 9, 2016 Michael Berry, MD The University of Tennessee Heath Science Center/The

More information

Adjuvant Systemic Therapy in Early Stage Breast Cancer

Adjuvant Systemic Therapy in Early Stage Breast Cancer Adjuvant Systemic Therapy in Early Stage Breast Cancer Julie R. Gralow, M.D. Director, Breast Medical Oncology Jill Bennett Endowed Professor of Breast Cancer Professor, Global Health University of Washington

More information

Terapia Hormonal da Paciente Premenopausa

Terapia Hormonal da Paciente Premenopausa I Congresso de Oncologia D Or 5 e 6 de julho de 2013 Terapia Hormonal da Paciente Premenopausa Antonio C. Wolff, MD, FACP, FASCO Professor de Oncologia Programa de Câncer de Mama Johns Hopkins University

More information

Guidelines for the treatment of Breast cancer with radiotherapy v.1.0 September 2017

Guidelines for the treatment of Breast cancer with radiotherapy v.1.0 September 2017 Guidelines for the treatment of Breast cancer with radiotherapy v.1.0 September 2017 Author: Dr Virginia Wolstenholme, Consultant Clinical Oncologist, Barts Health Date agreed: September 2017 Date to be

More information

SENTINEL LYMPH NODE BIOPSY FOR PATIENTS WITH EARLY-STAGE BREAST CANCER

SENTINEL LYMPH NODE BIOPSY FOR PATIENTS WITH EARLY-STAGE BREAST CANCER SENTINEL LYMPH NODE BIOPSY FOR PATIENTS WITH EARLY-STAGE BREAST CANCER Clinical Practice Guideline Update Introduction The original ASCO evidence-based clinical practice guidelines on use of sentinel node

More information

A Predictive Tool to Estimate the Risk of Axillary Metastases in Breast Cancer Patients with Negative Axillary Ultrasound

A Predictive Tool to Estimate the Risk of Axillary Metastases in Breast Cancer Patients with Negative Axillary Ultrasound Ann Surg Oncol (2014) 21:2229 2236 DOI 10.1245/s10434-014-3617-6 ORIGINAL ARTICLE BREAST ONCOLOGY A Predictive Tool to Estimate the Risk of Axillary Metastases in Breast Cancer Patients with Negative Axillary

More information

Adjuvant chemotherapy in older breast cancer patients: how to decide?

Adjuvant chemotherapy in older breast cancer patients: how to decide? Adjuvant chemotherapy in older breast cancer patients: how to decide? H. Wildiers University Hospitals Leuven Belgium Wildiers H, Kunkler I, Lancet Oncol 2007 Biganzoli L, Wildiers H, Lancet Oncol. 2012

More information

Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast-conserving therapy

Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast-conserving therapy Acta Oncologica ISSN: 0284-186X (Print) 1651-226X (Online) Journal homepage: http://www.tandfonline.com/loi/ionc20 Differences in outcome for positive margins in a large cohort of breast cancer patients

More information

Newly Diagnosed Breast Cancer: Preoperative Imaging and Localization

Newly Diagnosed Breast Cancer: Preoperative Imaging and Localization Newly Diagnosed Breast Cancer: Preoperative Imaging and Localization Debra Monticciolo, MD Professor of Radiology Texas A&M University no disclosures Debra Monticciolo, MD Professor of Radiology Texas

More information

Treating today s patients with tomorrow s solutions

Treating today s patients with tomorrow s solutions Treating today s patients with tomorrow s solutions 1st conference supported by: European Multidisciplinary Breast Cancer Collaborative (EMBCC) February 5-6, 2016 Maison des oceans Paris EMBCC board members

More information

ORIGINAL ARTICLE. International Journal of Surgery

ORIGINAL ARTICLE. International Journal of Surgery International Journal of Surgery (2013) 11(S1), S73 S78 Contents lists available at ScienceDirect International Journal of Surgery journal homepage: www.journal-surgery.net ORIGINAL ARTICLE Prognostic

More information

A Slow Starvation: Adjuvant Endocrine Therapy of Breast Cancer

A Slow Starvation: Adjuvant Endocrine Therapy of Breast Cancer A Slow Starvation: Adjuvant Endocrine Therapy of Breast Cancer Dr. Susan Ellard Surgical Oncology Update October 24, 2009 Disclosure slide Participant in various meetings or advisory boards sponsored by

More information

Breast Cancer Outcomes in Younger Women: A Systematic Review of the Literature on Locoregional Management. Amal Lina Khoury, MD

Breast Cancer Outcomes in Younger Women: A Systematic Review of the Literature on Locoregional Management. Amal Lina Khoury, MD Breast Cancer Outcomes in Younger Women: A Systematic Review of the Literature on Locoregional Management By Amal Lina Khoury, MD A Master s Paper submitted to the faculty of the University of North Carolina

More information

A case of a BRCA2-mutated ER+/HER2 breast cancer during pregnancy

A case of a BRCA2-mutated ER+/HER2 breast cancer during pregnancy ESMO Preceptorship Programme Breast Cancer Lisbon 16,17 September 2016 Emanuela Risi Sandro Pitigliani Medical Oncology Department Hospital of Prato, Istituto Toscano Tumori, Prato, Italy A case of a BRCA2-mutated

More information

ORIGINAL ARTICLE. Therapeutic Effect of Sentinel Lymphadenectomy in T1 Breast Cancer

ORIGINAL ARTICLE. Therapeutic Effect of Sentinel Lymphadenectomy in T1 Breast Cancer ORIGINAL ARTICLE Therapeutic Effect of Sentinel Lymphadenectomy in T1 Breast Cancer David W. Ollila, MD; Meghan B. Brennan, RN, BSN; Armando E. Giuliano, MD Objective: To evaluate whether the tumor status

More information

Optimal Management of Isolated HER2+ve Brain Metastases

Optimal Management of Isolated HER2+ve Brain Metastases Optimal Management of Isolated HER2+ve Brain Metastases Eliot Sims November 2013 Background Her2+ve patients 15% of all breast cancer Even with adjuvant trastuzumab 10-15% relapse Trastuzumab does not

More information

ACOSOG Thoracic Committee. Kemp H. Kernstine, MD PhD

ACOSOG Thoracic Committee. Kemp H. Kernstine, MD PhD ACOSOG Thoracic Committee Kemp H. Kernstine, MD PhD ACOSOG Thoracic Committee Chair: Bryan Meyers, M.D., MPH Vice Chairs: Malcolm Brock, MD Tom DiPetrillo, M.D. Ramaswamy Govindan, M.D. Carolyn Reed, MD

More information

Triple negative breast cancer -neoadjuvant and adjuvant systemic therapy

Triple negative breast cancer -neoadjuvant and adjuvant systemic therapy Triple negative breast cancer -neoadjuvant and adjuvant systemic therapy Sung-Bae Kim, MD, PhD Department of Oncology Asan Medical Center University of Ulsan College of Medicine Seoul, Korea DISCLOSURE

More information

Clinical Management Guideline for Breast Cancer

Clinical Management Guideline for Breast Cancer Initial Evaluation Clinical Stage Pre-Treatment Evaluation Treatment and pathological stage Adjuvant Treatment Less than 4 positive lymph nodes ER Positive HER2 Negative (see page 2 & 3 ) Primary Diagnosis:

More information

What s new in breast pathology? Penny Barnes MD, FRCP(C) May 17, 2016

What s new in breast pathology? Penny Barnes MD, FRCP(C) May 17, 2016 What s new in breast pathology? Penny Barnes MD, FRCP(C) May 17, 2016 Outline IHC markers of metastatic carcinoma of breast origin Uses and limitations of e-cadherin IHC Breast neoplasms with limited metastatic

More information

Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients

Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients http://dx.doi.org/10.7180/kmj.2016.31.1.19 KMJ Original Article Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients Yoon Seok

More information

Advances in gastric cancer: How to approach localised disease?

Advances in gastric cancer: How to approach localised disease? Advances in gastric cancer: How to approach localised disease? Andrés Cervantes Professor of Medicine Classical approach to localised gastric cancer Surgical resection Pathology assessment and estimation

More information

Non-anthracycline Adjuvant regimens in Early Breast Cancer. Yeesoo Chae, MD, PhD Medical Oncology Kyungpook National University Medical Center

Non-anthracycline Adjuvant regimens in Early Breast Cancer. Yeesoo Chae, MD, PhD Medical Oncology Kyungpook National University Medical Center Non-anthracycline Adjuvant regimens in Early Breast Cancer Yeesoo Chae, MD, PhD Medical Oncology Kyungpook National University Medical Center Contents Role of Anthracyclines in adjuvant treatment EBCTCG2012

More information

OPTIMAL ENDOCRINE THERAPY IN EARLY BREAST CANCER

OPTIMAL ENDOCRINE THERAPY IN EARLY BREAST CANCER OPTIMAL ENDOCRINE THERAPY IN EARLY BREAST CANCER STEPHEN E. JONES, M.D. US ONCOLOGY RESEARCH THE WOODLANDS, TX TOPICS PREMENOPAUSAL BREAST CANCER POSTMENOPAUSAL BREAST CANCER THE FUTURE TOPICS PREMENOPAUSAL

More information

Study Of Letrozole Extension. Coordinating Group IBCSG IBCSG BIG 1-07

Study Of Letrozole Extension. Coordinating Group IBCSG IBCSG BIG 1-07 tudy Of Letrozole Extension Coordinating Group IBCSG IBCSG 35-07 BIG 1-07 A phase III trial evaluating the role of continuous letrozole versus intermittent letrozole following 4 to 6 years of prior adjuvant

More information

Key Ouestions. to ask your medical oncology team after being diagnosed with breast cancer

Key Ouestions. to ask your medical oncology team after being diagnosed with breast cancer Key Ouestions to ask your medical oncology team after being diagnosed with breast cancer tips to make your visit with the physician a success: Bring this list of questions, a pen and paper to write down

More information

The Efficacy of Axillary Ultrasound in the Detection of Nodal Metastasis in Breast Cancer

The Efficacy of Axillary Ultrasound in the Detection of Nodal Metastasis in Breast Cancer Women s Imaging Original Research Lee et al. Ultrasound Detection of Nodal Metastasis Women s Imaging Original Research Belinda Lee 1 Adrian K. Lim 2 Jonathan Krell 1 Keshthra Satchithananda 2 R. Charles

More information

MammaPrint, the story of the 70-gene profile

MammaPrint, the story of the 70-gene profile MammaPrint, the story of the 70-gene profile René Bernards Professor of Molecular Carcinogenesis The Netherlands Cancer Institute Amsterdam Chief Scientific Officer Agendia Amsterdam The breast cancer

More information

Axillary Surgery in Breast Cancer: an overview

Axillary Surgery in Breast Cancer: an overview Journal of the Senologic International Society The World Society fo Breast Diseases Volume 2. Issue 1. 2013 REVIEW ARTICLE Axillary Surgery in Breast Cancer: an overview Cassio Furtini Haddad Department

More information

Mr Jaroslaw KRUPA, MD PhD Consultant Oncoplastic Breast Surgeon

Mr Jaroslaw KRUPA, MD PhD Consultant Oncoplastic Breast Surgeon Mr Jaroslaw KRUPA, MD PhD Consultant Oncoplastic Breast Surgeon Most common cancer affecting women ~1 in 8 women will be diagnosed in a lifetime Highest incidence in US and Northern Europe Natural history

More information

Update on Limited Small Cell Lung Cancer. Laurie E Gaspar MD, MBA Prof/Chair Radiation Oncology University of Colorado Denver

Update on Limited Small Cell Lung Cancer. Laurie E Gaspar MD, MBA Prof/Chair Radiation Oncology University of Colorado Denver Update on Limited Small Cell Lung Cancer Laurie E Gaspar MD, MBA Prof/Chair Radiation Oncology University of Colorado Denver Objectives - Limited Radiation Dose Radiation Timing Radiation Volume PCI Neurotoxicity

More information

Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the Literature

Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the Literature Ann Surg Oncol (2012) 19:4140 4149 DOI 10.1245/s10434-012-2490-4 ORIGINAL ARTICLE BREAST ONCOLOGY Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review

More information

University of Groningen. Local treatment in young breast cancer patients Joppe, Enje

University of Groningen. Local treatment in young breast cancer patients Joppe, Enje University of Groningen Local treatment in young breast cancer patients Joppe, Enje IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please

More information

Feasibility Of Day Surgery In Patients With Breast

Feasibility Of Day Surgery In Patients With Breast 583201SJS0010.1177/1457496915583201K. Ojala, J. H. Vironen, K. Mattila, A. M. Eklund, M. H. K. Leidenius, T. J. MeretojaScandinavian Journal of Surgery research-article2015 ORIGINAL ARTICLE Scandinavian

More information

RUTGERS CANCER INSTITUTE OF NEW JERSEY - ROBERT WOOD JOHNSON MEDICAL SCHOOL INTERDISCIPLINARY BREAST SURGERY FELLOWSHIP CORE EDUCATIONAL OBJECTIVES

RUTGERS CANCER INSTITUTE OF NEW JERSEY - ROBERT WOOD JOHNSON MEDICAL SCHOOL INTERDISCIPLINARY BREAST SURGERY FELLOWSHIP CORE EDUCATIONAL OBJECTIVES RUTGERS CANCER INSTITUTE OF NEW JERSEY - ROBERT WOOD JOHNSON MEDICAL SCHOOL INTERDISCIPLINARY BREAST SURGERY FELLOWSHIP CORE EDUCATIONAL OBJECTIVES At the completion of Breast Fellowship training, the

More information

ASTRO econtouring for Lymphoma. Stephanie Terezakis, MD

ASTRO econtouring for Lymphoma. Stephanie Terezakis, MD ASTRO econtouring for Lymphoma Stephanie Terezakis, MD Disclosures No conflicts to disclose 1970 Total Lymphoid Irradiation (TLI) 1995 Involved-Field Radiotherapy (IFRT) 2008 Involved Node Radiotherapy

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Accelerated Breast Irradiation and Brachytherapy Boost Page 1 of 23 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Accelerated Breast Irradiation and Brachytherapy

More information