Lectures in Early Breast Cancer A Power Point

Lectures in Early Breast Cancer A Power. Point slide set based on images from: Lectures in Early Breast Cancer Part 2: Management of Early Breast Cancer

Lectures in Early Breast Cancer A variety of reconstructive techniques are available today aimed at minimising the mutilation effect of mastectomy without compromising the oncological clearance (Ahmed et al, 2005).

Lectures in Early Breast Cancer (A) A schematic representation of the post-operative appearance after transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. (B) A 35 -year-old patient after skin-sparing mastectomy and immediate TRAM. Reproduced with permission from Dietz J et al. (2002).

Lectures in Early Breast Cancer (A) A schematic representation of latissimus dorsi (LD) flap breast reconstruction. (B) A 38 -year-old patient after modified radical mastectomy with immediate reconstruction using the LD flap and submuscular saline implant. Reproduced with permission from Dietz J et al. (2002).

Lectures in Early Breast Cancer There is no standard or preferred way of reconstruction (Ahmed et al. , 2005).

Lectures in Early Breast Cancer Data from Gazet et al. (1991, 1996).

Lectures in Early Breast Cancer Post-mastectomy radiotherapy (PMRT) has been shown to optimise locoregional control and improve survival. However, although all three recent PMRT randomised trials utilised internal mammary nodal irradiation, its exact contribution to the survival benefit is unclear. CMF, cyclophosphamide, methotrexate and 5 -fluorouracil. Data from Ragaz et al. (1997) and Overgaard et al. (1997, 1999).

Lectures in Early Breast Cancer Several trials of accelerated partial breast irradiation (APBI) were developed in the early 1990 s. These showed higher local recurrence rates of 15– 18%, but served to underscore the importance of tailoring APBI to a selected group of patients with low risk of local recurrence. ILC, invasive lobular carcinoma; EIC, extensive intraductal component. Data from Ribeiro et al. (1993), Fentiman et al. (2004), and Perera et al. (2003).

Lectures in Early Breast Cancer Careful attention to histopathology and quality assurance of treatment delivery is essential to ensure APBI is applied appropriately. To this end, both the American Brachytherapy Society (Arthur et al. , 2002) and the American Society of Breast Surgeons (ASBS, 2003) have published recommendations for patient selection criteria for accelerated partial breast irradiation (APBI).

Lectures in Early Breast Cancer There are emerging data that accelerated partial breast irradiation (APBI) may be a safe and effective technique in breast cancer treatment but this approach requires longer term randomised evidence, particularly with regards to its equivalence with whole-breast radiotherapy (WBRT) in terms of local recurrence rates and cosmetic outcomes. EBRT, external beam radiotherapy; HDR, high dose rate; PDR, pulsed dose rate. Data from NSABP B-39/RTOG 0413 Protocol, Strnad & Polgar (GEC-ESTRO Working Group), Vaidya et al. (2004), and Veronesi et al. (2003).

Lectures in Early Breast Cancer The EBCTCG confirmed that polychemotherapy produced substantial and highly significant proportional reductions in relation to the risk of relapse and death from breast cancer. The effects of treatment were described as either proportional or absolute benefits. For women under 50 years at randomisation, the absolute reduction in risk of relapse was 10. 4% for node-negative and 15. 4% for node-positive disease. The reduction was also significant for mortality (absolute improvements in 10 -year survival of 5. 7% and 12. 4% for node-negative and -positive disease, respectively). CMF, cyclophosphamide, methotrexate and 5 -fluorouracil. Reproduced with permission from the EBCTCG (2005).

Lectures in Early Breast Cancer For women aged 50– 69 years, the absolute reduction in relapse was approximately 5. 5% for both node-negative and node-positive individual, and rates in mortality showed absolute improvements in 10 -year survival of 6. 4% and 2. 3% for node-negative and -positive, respectively. CMF, cyclophosphamide, methotrexate and 5 -fluorouracil. Reproduced with permission from the EBCTCG (2005).

Lectures in Early Breast Cancer Early trials examining the use of anthracyclines were small, or used substandard anthracycline doses and/or regimens, and hence it required an overview to confirm their benefit over cyclophosphamide, methotrexate and 5 -fluorouracil (CMF). Reproduced with permission from the EBCTCG (2005).

Lectures in Early Breast Cancer AC, doxorubicin, cyclophosphamide; FAC, 5 -fluorouracil, cyclophosphamide, doxorubicin; FEC, 5 -fluorouracil, cyclophosphamide, epirubicin; HR, hazard ratio; OS, overall survival; T, docetaxel; TAC, docetaxel, doxorubicin, cyclophosphamide; TC, docetaxol, cyclophosphamide. Data from Nabholtz et al. (2002), Jones et al. (2003), Roche et al. (2004), and Bear et al. (2003).

Lectures in Early Breast Cancer AC, doxorubicin, cyclophosphamide; HR, hazard ratio; OS, overall survival; T, paclitaxel. Data from Henderson et al. (2003) and Mamounas et al. (2003).

Lectures in Early Breast Cancer Following the success of trastuzumab in metastatic breast cancer, four large international multicentre trials were designed to test the efficacy of trastuzumab as adjuvant treatment either with or following chemotherapy. *Group B from N 9831 and Group A from HERA were excluded from the analysis. AC, doxorubicin, cyclophosphamide; LN, lymph node. Data from Romond et al. (2005), Piccart-Gebhart et al. (2005), and Slamon et al. (2005).

Lectures in Early Breast Cancer *Excluding group B from N 9831. †Hazard ratio (HR) calculated for a first event. ‡HR calculated for death. DFS, disease-free survival; HR, hazard ratio; NS, not significant; OS, overall survival; T, trastuzumab-treated arm. Data from Romond et al. (2005) and Piccart-Gebhart et al. (2005).

Lectures in Early Breast Cancer ACTH, doxorubicin, cyclophosphamide, docetaxel, trastuzumab; DFS, disease-free survival; HR, hazard ratio; NS, not significant; OS, overall survival; T, trastuzumab-treated arm; TCH, docetaxel, carboplatin, trastuzumab. Data from Slamon et al. (2005).

Lectures in Early Breast Cancer There are international consensus guidelines based on clinicopathological features and outcomes, which are regularly updated to help inform local guidelines and individual clinicians. The 2005 St Gallen guidelines have defined low-, intermediate- and high-risk categories. Adapted from Piccart et al. (2005).

Lectures in Early Breast Cancer The 2005 St Gallen guidelines recommend adjuvant treatment according to risk and endocrine responsiveness. *Depending on clinician and patient discussion. ET, endocrine therapy; CT, chemotherapy. Adapted from Piccart et al. (2005).

Lectures in Early Breast Cancer AC, doxorubicin, cyclophosphamide; CAF, cyclophosphamide, doxorubicin, 5 -fluorouracil; CEF, cyclophosphamide, epirubicin, 5 -fluorouracil; CMF, cyclophosphamide, methotrexate, 5 -fluorouracil; CT, chemotherapy; FEC, 5 -fluorouracil, cyclophosphamide, epirubicin; TAC, docetaxel, doxorubicin, cyclophosphamide. Adapted from Piccart et al. (2005).

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