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EARLY BREAST CANCER

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arunmp's version from 2016-12-17 12:28

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EARLY BREAT CANCER
Question Answer
Per NSABP B04 what % of women with a clinically negative axilla were found to have axillary mets at LND40%
Per NSABP B04 Of the women who had a clinically – axilla and did not have a nodal dissection, what % eventually developed a clinically + axilla?20%
Role of MRI in breastextent of Dx/multifocal Dz
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How should the axilla be staged?
Question Answer
If palpable or radiologically visible LNFNA/core Bx to confirm → full axillary lymph node dissection (ALND) (levels I and II) at the time of surgery.
If no palpable or radiologically visible LNsentinel lymph node dissection (SLND) is preferred over ALND in early-stage Dz.
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Question Answer
Which major trials showed SLND Bx as an alternative to ALND forsentinel node–negative pts?NSABP 32, ALMANAC TRIAL ,MILAN TRIAL
NSABP 32 compared ---- versus ----SLN Bx + immediate completion axillary LND vs. SLN Bx alone.
Which major trials showed post SLND Bx with 1 to2 sentinel node positive, ALND versus no dissection for pts?Alliance trial or ACOSOGZ0011
Both NSABP B32 and ALMANAC showed what advantage if we are doing SLNB instead of ALND decreased risk of lymphedema and arm numbness with SLN Bx.
If T1 or T2 tumor, 1 or 2 + SLN Post BCS.What next ?whole breast irradiation (WBI) ONLY BUT USE HIGH TANGENTS
Paget Dz associated with underlying breast cancer should be staged according to theT stage of the underlying cancer (Tis, T1, etc.).
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Question Answer
What does the Oncotype DX score tell you?Risk of distant recurrence within 10 yrs of Dx with 5 yrs endocrine therapy alone in ER+, N0 pts who undergo upfront surgery.
Low recurrence score (<18) → adj endocrine Tx
Intermediate recurrence score (18–30) → adj endocrine +/– chemo
High recurrence score (≥31) →adj endocrine + chemo
chemo regimens are recommended for HER2– tumors?Dose-dense AC followed by paclitaxel q1wk × 12
chemo regimens are recommended for HER2+ tumors?AC followed by T plus concurrent trastuzumab (various schedules), followed by single-agent trastuzumab q3wk for a total of 1 yr
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Question Answer
What data suggest that results of BCT can be further improved with the use of tamoxifen?NSABP B21 (Fisher B et al., JCO 2002)1,009 pts with ≤1-cm tumors s/p lumpectomy randomized to 3 arms(a) tamoxifen alone (10 mg bid × 5 yrs), (b) RT alone (50 Gy), and (c) RT + tamoxifen. After 8-yr follow-up, the IBTR was 16.5% with tamoxifen alone vs. 9.3% with RT alone vs. 2.8% with RT + tamoxifen
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Suitable for apbi
Question Answer
Age>60
ER+
rule of 2 means<2 cm idc & >2mm margin
NO boldBRAC,NODES, LVSI,DCIS
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Question Answer
In early breast cancer which group u can avoid rt
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Lumianal A has lowest risk of llocal recurrence