Tumor Board 2014-Feb13-v7_(copy01)

Bcsvsbcsrt mastectomyvsbcsvsbcsrt b06fishernejm1995

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Unformatted text preview: removal of breast, overlying skin, pectoralis major/minor, Level I, II, III nodes Early Thinking Early Thinking Halstedian dogma – “More is better” Landmark trial NSABP B­04 – Radical mastectomy vs. simple mastectomy and nodal irradiation vs. simple mastectomy with axillary observation – 25 years of follow up showed NO significant differences in distant disease free survival Mastectomy vs. BCS vs. BCS + RT Mastectomy vs. BCS vs. BCS + RT B06 (Fisher, NEJM 1995) N= 1851 Stage I/II ( < 4cm, node +/­, all ALND) – 62% node –ve, 26% 1­3 nodes, 12% > 4nodes – Chemo node+ve was Melphalan + 5­FU Results (20 year follow up) – No diff DFS among 3 groups (36% vs 35% vs 35%) 69% of any recurrences within 5 yrs – No diff OS among 3 groups (47% vs 46% vs 46%) B06 (Fisher, NEJM 1995) – B06 (Fisher, NEJM 1995) – ipsilateral BC recurrence rate BCS 20 yr IBRT BCS + RT All comers 39% 14% Node ­ve 36% 17% Node +ve 44% 8% 2/3rds reduction in risk of recurrence with RT Mastectomy Vs. BCS + RT Mastectomy Vs. BCS + RT Breast Conserving Therapy (BCT) Breast Conserving Therapy (BCT) Radiotherapy can be delivered safely and effectively – This development was pivotal to development of BCT Results in breast preservation and equivalent survival outcomes For Stage I ­II Breast Cancer BCS + Radiation = Mastectomy BCS + Radiation = Mastectomy Disease Free Survival Distant Metastases Overall Survival @ 20 yrs Extended Radical Mastectomy BCBCBCS Basics of Radiotherapy Basics of Radiotherapy Linear Accelerator 3D Planning 075281 3D Planning 3D Planning Acute Side Effects of RT Acute Side Effects of RT Fatigue Skin Reaction Subacute side effects of RT Subacute side effects of RT RT pneumonitis Late Side Effects of RT Late Side Effects of RT Skin changes Hyperpigmentation, fibrosis, telangectasia Breast changes Firmness, tenderness Rib/Chest wall tenderness Lymphedema...
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