Download breast cancer

Breast Cancer and
Chemotherapy.
Dr.Kensarah
Tuesday, 23 May 2017
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TNM Classification
Staging
Management of Breast Cancer
Neoadjuvant Chemotherapy
Adjuvant Chemotherapy
Tuesday, 23 May 2017
TNM classification
• Primary tumor (T) :
TX: Primary tumor cannot be
assessed.
T0: No evidence of primary tumor
Tis : DCIS, LCIS, Paget’s disease
of the nipple with no tumor .
Tuesday, 23 May 2017
TNM classification
 T1: Tumor ≤2.0 cm in greatest
dimension
 T1mic: Microinvasion ≤0.1 cm in
greatest dimension
 T1a: Tumor >0.1 cm but ≤0.5 cm in
greatest dimension
 T1b: Tumor >0.5 cm but ≤1.0 cm in
greatest dimension
 T1c: Tumor >1.0 cm but ≤2.0 cm in
greatest dimension
Tuesday, 23 May 2017
TNM classification
T2: Tumor >2.0 cm but ≤5.0 cm in
greatest dimension
T3: Tumor >5.0 cm in greatest
dimension
T4: Tumor of any size with direct
extension to (a) chest wall or (b)
skin.
Tuesday, 23 May 2017
TNM classification
T4a: Extension to chest wall, not
including pectoralis muscle.
T4b: Edema (including peau
d’orange) or ulceration of the skin
of the breast.
T4c: Both T4a and T4b
 T4d: Inflammatory carcinoma
Tuesday, 23 May 2017
TNM classification
• Regional lymph nodes (N) :
 NX: Regional lymph nodes cannot be
assessed (e.g., previously removed)
 N0: No regional lymph node
metastasis
 N1: Metastasis to movable ipsilateral
axillary lymph node(s)
Tuesday, 23 May 2017
TNM classification
N2: Metastasis to ipsilateral
axillary lymph node(s) fixed or
matted, or in clinically apparent*
ipsilateral internal mammary
nodes in the absence of clinically
evident lymph node metastasis
Tuesday, 23 May 2017
TNM classification
 N3: N3a: Metastasis in ipsilateral
infraclavicular lymph node(s)
 N3b: Metastasis in ipsilateral
internal mammary lymph node(s)
and axillary lymph node(s)
 N3c: Metastasis in ipsilateral
supraclavicular lymph node(s)
Tuesday, 23 May 2017
Staging of Breast Cancer
Stage Tumor
Size
L.N
involvement
Metastasis
I
< 2 cm
No
No
II
2-5 cm
No or in
No
same side of
breast
III
> 5 cm
Yes on same No
side of
breast
IV
Yes
Management of Breast Cancer
A) In situ Breast Cancer:
I ) LCIS :
Observation with or w/o
Tamoxifen
The goal of treatment is to prevent
or detect cancer in early stages,
which might develop in 25-35%
Tuesday, 23 May 2017
Management of Breast Cancer
There is no benefit to excising
LCIS, as the disease diffusely
involves both breasts and the risk
of invasive cancer is equal for
both breasts
Tuesday, 23 May 2017
Management of Breast Cancer
II) DCIS :
For women with widespread
disease ( 2 or more quadrants )
→ Mastectomy
For women with limited disease
→ Lumpectomy and Radiation
Tuesday, 23 May 2017
Management of Breast Cancer
B) Early Invasive Breast Cancer :
Includes stage I,IIa , or IIb
Mastectomy or Lumpectomy and
radiation therapy
Axillary Lymph node dissection .
Tuesday, 23 May 2017
Management of Breast Cancer
•
1.
2.
3.
4.
Relative Contraindication to
breast conservation therapy :
Prior radiation therapy to the
breast or chest wall.
Positive surgical margins.
Multicentric disease
Scleroderma
Tuesday, 23 May 2017
Management of Breast Cancer
B) Early Invasive Breast Cancer :
Adjuvant Chemotherapy is
considered for all node positive
patients, tumor > 1 cm.
Tamoxifen is considered for
hormone receptor positive
patients with cancer > 1 cm
Tuesday, 23 May 2017
Management of Breast Cancer
C) Advanced Regional Breast
Cancer :
1. Operable stage III A :
 MRM followed by adjuvant
chemotherapy, followed by
adjuvant radiotherapy.
Tuesday, 23 May 2017
Management of Breast Cancer
2.inoperable stage III a and stage III
b:
Neoadjuvant chemotherapy
MRM , followed by adjuvant
chemotherapy, followed by
adjuvant radiotherapy.
Tuesday, 23 May 2017
Management of Breast Cancer
D) Distant metastases:
Treatment for stage IV breast
cancer is not curative
Goal: prolong survival and
enhance a women’s quality of life.
Hormonal therapy preferred
versus chemotherapy.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• 7 prospective , randomized trials
have evaluated the efficacy of
chemotherapy administered in the
neoadjuvant setting prior to breast
surgery versus administered in
the adjuvant setting after surgery
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• Although two of these trials
reported improvement in disease
free survival with the use of
neoadjuvant chemotherapy, none
have demonstrated improvement
in overall survival.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• Consistently, patients treated with
neoadjuvant chemotherapy were
more likely to be treated with
breast conservation.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• From a practical perspective, prior
to initiating chemotherapy in the
neoadjuvant setting, under image
guidance, a metalic clip is placed
into the tumor.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• IF a complete clinical and
radiological tumor response
occur, preoperative stereotactic
wire placement alongside the clip
will facilitate excision of the tumor
site.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• If histology demonstrates a
localized tumor with negative
margins, radiation can commence
and the breast preserved.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• For a diffuse tumor with satellite
lesions, consideration of excision
prior to radiation should be given
even if the margins are technically
cleared.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• For a diffuse tumor with many
satellite foci and positive margins,
mastectomy maybe required.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy for
Operable Breast Cancer
• Neoadjuvant therapy can achieve
high response rates and may
permit conservative surgery in
more advanced breast cancer.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy for
Operable Breast Cancer
• There are reasons to apply to apply
this treatment to earlier stages of
Cancer
1st : for the lower tumor burdens, the
probability of drug resistance cells is
theoretically less.
Definition: Refers to the number of cancer cells, the size of a tumor, or the
amount of cancer in the body; Tumor load
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy for
Operable Breast Cancer
2nd : the absolute number of tumor
cells left after treating a small
tumor burden may be below a
threshold, above which re-growth
will occur.ie, no recurrence .
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy for
Operable Breast Cancer
• For these and other concerns,
investigators have treated earlier
stage patients with preoperative
chemotherapy.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• “Success of neoadjuvant
chemotherapy in conversion of
mastectomy to breast
conservation surgery.”
•
Harbor-UCLA Medical Center, Torrance, California, USA
Surg. 2006 Oct;72(10):935-8
Tuesday, 23 May 2017
, Am
Neoadjuvant Chemotherapy
• Objective: to determine the
success of Neoadjuvant
Chemotherapy in achieving
Breast conservation in women
who initially were not candidates
for BC.
• Harbor-UCLA Medical Center, Torrance, California, USA , Am
Surg. 2006 Oct;72(10):935-8
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• Tumors were predominantly
infiltrating ductal carcinoma
(83.3% )
• high grade (62.2% )
• Chemo: Cyclophosphamide,
Doxorubicin and 5 FU.
•
Harbor-UCLA Medical Center, Torrance, California, USA
Surg. 2006 Oct;72(10):935-8
Tuesday, 23 May 2017
, Am
Neoadjuvant Chemotherapy
• Mean tumor size was 51 mm.
• 62 % were larger than 4 cm.
•
Harbor-UCLA Medical Center, Torrance, California, USA
Surg. 2006 Oct;72(10):935-8
Tuesday, 23 May 2017
, Am
Neoadjuvant Chemotherapy
• Results:
- Complete clinical response was
seen in 32.4 %
- Complete pathological response
was seen in 10.8 %
• Harbor-UCLA Medical Center, Torrance, California, USA , Am
Surg. 2006 Oct;72(10):935-8
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• BC was achieved in 56.7 per cent
of cases.
• Only initial tumor size predicted
tumor regression and success of
BC . Neither Histology nor
biological marker.
• Harbor-UCLA Medical Center, Torrance, California, USA , Am
Surg. 2006 Oct;72(10):935-8
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• “Axillary lymph node count is
lower after neoadjuvant
chemotherapy”
PMID: 16720159 [PubMed - indexed for MEDLINE]. Am J Surg. 2006
.
Jun;191(6):830-1
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
Results:
A total of 143 patients recived NC
first.
170 patients received surgery first
PMID: 16720159 [PubMed - indexed for MEDLINE]. Am J Surg. 2006
Jun;191(6):830-1.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
Patients treated with neoadjuvant
chemotherapy had fewer than 10
L.N retrieved at ALND than
patients who had the surgery first.
PMID: 16720159 [PubMed - indexed for MEDLINE]. Am J Surg. 2006
Jun;191(6):830-1.
Tuesday, 23 May 2017
Neoadjuvant Chemotherapy
• CONCLUSION:
A low lymph node count is more
common in patients after
treatment with neoadjuvant
chemotherapy.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
• “Prognostic significance of
pathological response of primary
tumor and metastatic axillary
lymph nodes after neoadjuvant
chemotherapy for locally
advanced breast carcinoma.”
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
• PATIENTS AND METHODS:
Between January 1989 and April
1995, 148 consecutive patients
with locally advanced breast
carcinoma participated in the
study.
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
 Of these, 140 patients were
treated with three courses of 5fluorouracil, doxorubicin, and
cyclophosphamide (FAC),
followed by modified radical
mastectomy or definitive radiation
therapy.
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
• RESULTS:
 Complete response occurred in 11
patients (8%)
 Partial response occurred in 88
patients (63%).
 No change was recorded in 37
patients (26%)
 and progressive disease occurred in 4
patients (3%)
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
Maximal pathological response of
the primary tumor (in situ
carcinoma or minimal microscopic
residual tumor) was observed in
24 (18%)
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
112 patients (82%) presented
minimal pathological response of
the primary tumor.
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
• A significant correlation was noted
between pathological response of
primary tumor and the number of
metastatic axillary lymph nodes
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
• CONCLUSION:
 After neoadjuvant chemotherapy,
pathological responses of both primary
tumor and metastatic axillary lymph
nodes had a marked prognostic
significance and influenced outcome
for patients with locally advanced
breast carcinoma.
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Pathological Response after
neoadjuvant chemo
The results suggest that maximal
tumor shrinkage of potentially
involved axillary nodes may
represent a major goal of
neoadjuvant chemotherapy
Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.
Tuesday, 23 May 2017
Adjuvant Chemotherapy for
Operable Breast Cancer
• The first trials of prolonged
postoperative chemotherapy in
operable breast cancer were started
by the “National Surgical Adjuvant
Breast and Bowel Project “(NSABP) in
1972 and by the “NCI “ National
Cancer institue” of Italy in 1973
Tuesday, 23 May 2017
Adjuvant Chemotherapy for
Operable Breast Cancer
• The results from these two trials
are similar and convincingly
positive for women undergoing
chemotherapy who are younger
than 50 years of age.
Tuesday, 23 May 2017
Adjuvant Chemotherapy for
Operable Breast Cancer
• In contrast to the positive effect of
chemotherapy in younger
patients, women older than 50
years of age did not significantly
benefit from the use of adjuvant
cytotoxic chemotherapy.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast
Cancer
In respect to adjuvant chemotherapy,
information from more than 30,000
women in 69 trials was collected.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• These patients were involved in
randomization between :
 polychemotherapy Vs no treatment
(18,000)
 longer Vs shorter polychemotherapy
(6000)
 anthracyclin containing regimens Vs CMF
( 6000)
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• Overall, the results showed that
patients who received treatment
had a proportional reduction in the
recurrence of 23.5 % and a
proportional reduction in death of
15.3 %
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• Absolute benefits appear greater
for node-positive patients than for
node-negative patients.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• However, the reduction in annual
odds of recurrence is similar.
• 28 % for node-negative patients
• 33% for node-positive women.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• In summary:
 adjuvant chemotherapy with
multiple drugs produces a
statistically significant reduction in
the odds of breast cancer
recurrence or death
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• In summary:
Is thought to be proportionately
similar in node-positive and nodenegative patients.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• The rule of constant proportional
benefit is not entirely true.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• The benefits of adjuvant
polychemotherapy appeared to be
greatest in younger women, with
an inverse relationship of benefit
to age.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• For women younger than 40,
polychemotherapy reduced the
odds of recurrence by 37% and
death by 28%
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• This benefit tended to decline in
older women.
• However, even for women aged
60 – 69 when randomized,
chemotherapy reduced the
proportion with recurrence by 18%
and the proportion dying by 9%
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• Women older than 70 years did
not appear to benefit from the
addition of adjuvant
polychemotherapy.
Tuesday, 23 May 2017
Meta- Analysis of Adjuvant
Chemotherapy for Breast Cancer
• A small advantage of
anthracycline- containing
regimens was also seen in this
large analysis
•
Anthracyclines : such as doxorubicin and epirubicin
Tuesday, 23 May 2017
Newer approaches in
chemotherapy for Breast Cancer
• Dose intensity:
In the analysis of the Milan CMF
trial, the question of
chemotherapy dose was
investigated as a determination of
effectiveness.
Tuesday, 23 May 2017
Newer approaches in
chemotherapy for Breast Cancer
• The outcome of patients receiving
more than 85% of their calculated
chemotherapy dose was
significantly better than for
patients who received less than
65% of their scheduled dose.
Tuesday, 23 May 2017
Newer approaches in
chemotherapy for Breast Cancer
• This has led to the hypothesis that
Dose intensity of chemotherapy is
important in patient outcome.
Tuesday, 23 May 2017
New agents
• Addition of the novel class of drugs,
the taxanes, to the doxorubicincontaining regimens in CALGB
resulted in an improved disease free
and overall survival outlook.
•
Journal of the National Cancer Institute Monographs, No. 30, 88-95,
2001
•
CALGB : Cancer And Leukemia Group B
Tuesday, 23 May 2017
New Agents: Taxanes
• The taxanes are a group of drugs
that includes :
1. Paclitaxel (Taxol)
2. Docetaxel (Taxotere
Taxanes : Antimitotic Agent.
Tuesday, 23 May 2017
New Agents:Taxanes
• Paclitaxel and docetaxel
undoubtedly represent the most
active chemotherapeutic agents
developed in the last decade for
the treatment of advanced breast
cancer
•
Journal of the National Cancer Institute Monographs, No. 30,
88-95, 2001
Tuesday, 23 May 2017
New Agents:Taxanes
• Outstanding features of these agents
includes:
 first, the mechanism of action.
They affect cell structures called
microtubules, which play an important
role in cell functions.
•
Journal of the National Cancer Institute Monographs, No. 30, 88-95,
2001
Tuesday, 23 May 2017
New Agents: Taxanes
• In normal cell growth,
microtubules are formed when a
cell starts dividing.
• Once the cell stops dividing, the
microtubules are broken down or
destroyed.
Tuesday, 23 May 2017
New Agents: Taxanes
• Taxanes stop the microtubules
from breaking down; cancer cells
become so clogged with
microtubules that they cannot
grow and divide.
Tuesday, 23 May 2017
New Agents: Taxanes
 Second:
Their capacity to be combined with
almost all active chemotherapeutic
agents commonly used for breast
cancer therapy.
•
Journal of the National Cancer Institute Monographs, No. 30, 88-95,
2001
Tuesday, 23 May 2017
Cell cycle
Tuesday, 23 May 2017
New Agents: Taxanes
• The large U.S. Intergroup trial, referred
to as Cancer and Leukemia Group B
(CALGB) 9344, explored the value of
adding four cycles of paclitaxel to four
cycles of AC (doxorubicin–
cyclophosphamide) as postoperative
adjuvant therapy of lymph nodepositive breast cancer in 3170 women
Tuesday, 23 May 2017
New Agents: Taxanes
• The superior results of the paclitaxel arm
were reported at its first planned interim
analysis, conducted at a median follow-up
time of 20 months, and were presented at the
1998 meeting of the American Society of
Clinical Oncology (ASCO) *
*
Henderson IC, et al. Improved disease-free and overall
survival from the addition of sequential paclitaxel but not
from the escalation of doxorubicin dose level in the adjuvant
chemotherapy of patients with node-positive primary breast
cancer [abstract]. Proc ASCO 1998;17:101a.
Tuesday, 23 May 2017
New Agents: Taxanes
• an update with a median follow-up
of 30 months was presented to
the ODAC (Oncology Drug
Advisory Committee) with
subsequent registration of the
paclitaxel-based adjuvant regimen
for lymph node-positive disease
by the FDA in late 1999.
Tuesday, 23 May 2017
New Agents: Taxanes
• Side effects of Taxanes:
1.Nausea and vomiting
2.Bone Marrow suppression
3.Hypersensitivity Recation
4.Joint and muscle pain.
5.Loss of hair.
Tuesday, 23 May 2017
New agents : Trastuzumab
• Trastuzumab ( Herceptin) is a
humanized murine monoclonal
antibody raised against the erbB-2
or HER2 surface receptor.
Tuesday, 23 May 2017
New agents : Trastuzumab
• This receptor related to erbB-1 or
the epidermal growth factor
receptor (EGFr), is the target
gene amplification and high level
overexpression in about 20% of
patients of human breast cancer.
Tuesday, 23 May 2017
New agents : Trastuzumab
• Overexpression of the protein
product of the erbB-2 gene is
measured by
immunohistochemistry and
usually quantitatively expressed
from zero to 3+
Tuesday, 23 May 2017
New agents : Trastuzumab
• Gene amplification is measured
by the fluorescent in Situ
hybridization (FISH).
• Those cancers with 3+ expression
or amplification by FISH may
respond to trastuzumab.
Tuesday, 23 May 2017
New agents : Trastuzumab
• Her2/neu activation initiates
signalling cascades that result in
proliferation, angiogenesis and
survival of breast cancer cells.
• Trastuzumab is a monoclonal
antibody against Her2.
•
Fox Chase Cancer Center, Division of Medical Sciences, Department of
Medical Oncology, 333 Cottman Ave, Philadelphia, PA 19111, USA.
Tuesday, 23 May 2017
New agents : Trastuzumab
• When trastuzumab is used
preoperatively, apoptosis is seen
in resected tumours.
•
Fox Chase Cancer Center, Division of Medical Sciences, Department of
Medical Oncology, 333 Cottman Ave, Philadelphia, PA 19111, USA.
Tuesday, 23 May 2017
New agents : Trastuzumab
• In the adjuvant setting, large,
randomised trials demonstrate
improved outcome for
trastuzumab with chemotherapy
followed by a year of trastuzumab.
Tuesday, 23 May 2017
New agents : Trastuzumab
• In fact, addition of trastuzumab to
conventional chemotherapy has
improved survival in metastatic
breast cancer patients, and some
patients have experienced
dramatic regression of cancer.
Tuesday, 23 May 2017
New agents : Trastuzumab
• Limitation to this approach are:
1.relatively small number of patients
with HER2-positive tumors
2. The addidative adverse effects of
trastuzumab and anthracyclines
on cardiac function.
Tuesday, 23 May 2017
New agents : Trastuzumab
3. Very expensive.
Approx. Price: $3047.21 per 1Each
GENENTECH, INC.
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
“Effects of chemotherapy and hormonal
therapy for early breast cancer on
recurrence and 15-year survival: an
overview of the randomised trials.”
•
Lancet. 2005 May 14-20;365(9472):1687-717
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
• randomised trials in early breast
cancer have assessed the 5 year
and 10-year effects of various
systemic adjuvant therapies on
breast cancer recurrence and
survival (1985-2000)
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
• FINDINGS:
Allocation to about 6 months of
anthracycline-based
polychemotherapy (eg, with FAC)
reduced the annual breast cancer
death rate by about 38% for
women younger than 50 years
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
The Annual breast cancer death
rate reduced by about 20% for
those of age 50-69 years , largely
irrespective of the use of
tamoxifen and of oestrogen
receptor (ER) status, nodal status,
or other tumour characteristics.
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
• For ER-positive disease only,
allocation to about 5 years of
adjuvant Tamoxifen reduces the
annual breast cancer death rate
by 31%.
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
• 5 years are significantly more
effective than just 1-2 years of
tamoxifen
Tuesday, 23 May 2017
Early Breast Cancer Trialists'
Collaborative Group (EBCTCG)
• For middle-aged women with ERpositive disease (the commonest type
of breast cancer), the breast cancer
mortality rate was decreased by 50 %
throughout the next 15 years after 6
months of anthracycline-based
chemotherapy (with a combination
such as FAC ) followed by 5 years of
adjuvant tamoxifen
Tuesday, 23 May 2017
Preoperative Vs Post operative
chemotherapy
• Impact of Preoperative Versus
Postoperative Chemotherapy on
the Extent and Number of
Surgical Procedures in Patients
Treated in Randomized Clinical
Trials for Breast Cancer
Tuesday, 23 May 2017
Preoperative Vs Post operative
chemotherapy
• Methods:
The records of 509 consecutive
patients with T1-T3, N0-N2 breast
cancer who were treated in
prospective randomized clinical
trials of chemotherapy between
1998 and 2005.
Tuesday, 23 May 2017
Preoperative Vs Post operative
chemotherapy
• Analysis included:
The final surgical procedure (BCT
or mastectomy),
The number of operations
 In patients who underwent BCT,
re-excision rates,
the total volume of breast tissue
excised
Tuesday, 23 May 2017
Preoperative Vs Post operative
chemotherapy
•
o
o
o
Results:
total of 241 patients underwent BCT,
268 patients underwent mastectomy.
Among BCT patients who had initial tumor
size >2.0 cm, patients who received
preoperative chemotherapy had significantly
smaller volumes of breast tissue excised
compared with patients who received
postoperative chemotherapy (113 cm3 vs.
213 cm3, P = 0.004).
Tuesday, 23 May 2017
Preoperative Vs Post operative
chemotherapy
o The re-excision rate and total
number of breast operations did
not significantly differ between the
groups.
Tuesday, 23 May 2017
Preoperative Vs Post operative
chemotherapy
o Among BCT patients who had
initial tumor size <=2 cm,
preoperative chemotherapy had
no impact on volume of breast
tissue excised, re-excision rate, or
number of breast operations (P >
0.05).
Tuesday, 23 May 2017