OPTIONS FOR BREAST SURGERY IN THIS PATIENT INCLUDE ALL OF THE - - PowerPoint PPT Presentation

OPTIONS FOR BREAST SURGERY IN THIS PATIENT INCLUDE ALL OF THE FOLLOWING EXCEPT:

• A - Pa rtia l Ma ste c to my
• B - Simple Ma ste c to my
• C - Clinic a l c o mple te

re spo nse , no surg e ry

• D - Skin Spa ring

Ma ste c to my with Re c o nstruc tio n

ALL OF THE FOLLOWING ARE TRUE OF SENTINEL LYMPH NODE AFTER NEOADJUVANT CHEMOTHERAPY EXCEPT:

• A - Displa ys a n lo we r fa lse ne g a tive ra te
• B - I

s mo re a c c ura te with the use o f dua l tra c e r

• C - I

s mo re a c c ura te whe n mo re lymph no de s a re ide ntifie d

• D - I

s no t indic a te d in infla mma to ry b re a st c a nc e r

ALL OF THE FOLLOWING ARE TRUE OF SENTINEL LYMPH NODE AFTER NEOADJUVANT CHEMOTHERAPY EXCEPT:

• A. A - Displa ys a n lo we r

fa lse ne g a tive ra te

• B. B - I

s mo re a c c ura te with the use o f dua l tra c e r

• C. C - I

s mo re a c c ura te whe n mo re lymph no de s a re ide ntifie d

• D. D - I

s no t indic a te d in infla mma to ry b re a st c a nc e r

ALL OF THE FOLLOWING ARE TRUE OF SENTINEL LYMPH NODE AFTER NEOADJUVANT CHEMOTHERAPY EXCEPT:

• A. Displa ys a n lo we r fa lse

ne g a tive ra te

• B. I

s mo re a c c ura te with the use o f dua l tra c e r

• C. I

s mo re a c c ura te whe n mo re lymph no de s a re ide ntifie d

• D. I

s no t indic a te d in infla mma to ry b re a st c a nc e r

CONSIDERATIONS IN BREAST SURGERY AFTER CHEMOTHERAPY

CLIP PLACEMENT

• I

s impo rta nt in a ll b re a st b io psie s b ut is ma nda to ry in ne o a djuva nt pa tie nts

SAME PATIENT AFTER CHEMO, CLIPS ARE ALL THAT REMAIN

WHAT IF THE PATIENT HAS A CCR?

• Ma uri e t a l in 2005, me ta -a na lysis o f ne o vs

a djuva nt c he mo

• Sho we d no diffe re nc e in OS, DF

S, a nd DDF S

• Sho we d a sig nific a nt inc re a se in L

RR in the ne o -a djuva nt a rms

• 22% inc re a se
• Drive n b y 4 studie s whe re surg e ry wa s

re pla c e d b y ra dia tio n in c CR

• Whe n the se studie s we re pulle d o ut L

RR is the sa me

• I

ma g ing is ina c c ura te a t a sse ssing re sidua l dise a se

Ma uri D, Pa vlidis N, I

• a nnidis JP. Ne o a djuva nt ve rsus a djuva nt syste mic tre a tme nt in b re a st c a nc e r: a me ta -a na lysis. J NatlCanc e r I
• nst. F

e b 2 2005;97(3):188-194 Dia la ni V, Cha da shvili T , Sla ne tz PJ. Ro le o f ima g ing in ne o a djuva nt the ra py fo r b re a st c a nc e r. Ann S urg Onc o l. Ma y 2015;22(5):1416-1424

WHILE THE PATIENT IS GETTING CHEMOTHERAPY

• Ge ne tic te sting if

indic a te d

• Visit the pla stic surg e o n if

indic a te d

• Midpo int visit with surg e o n

to re a sse ss tumo r/ g o a ls

• Re -ima g e b re a st/ a xilla if it

will c ha ng e thing s

SURGERY DECISION MAKING

• OS is the sa me b e twe e n pa rtia l a nd c o mple te

ma ste c to my

• L

RR is hig he r in pa rtia l e ve n with ra dia tio n b ut no t e no ug h to impa c t surviva l

• Surg e ry de c isio n ma king drive n b y:
• Da ta
• Co sme sis
• Po st Ma ste c to my Ra dia tio n
• F

e a r

SIMPLE SURGERY OPTIONS

• L

umpe c to my

• Quic k re c o ve ry
• Po ssib ility o f ma rg in po sitivity
• Ca n b e do ne with a b re a st

re duc tio n “o nc o pla stic ”

• Simple Ma ste c to my
• Quic k re c o ve ry
• F

itte d fo r pro sthe sis in 8 we e ks

MORE COMPLEX OPTIONS

• Skin Spa ring Ma ste c to my
• Nipple c a n b e re c o nstruc te d a t a la te r

da te

• Nipple Spa ring Ma ste c to my
• Nic e st c o sme tic o utc o me b ut le a ve s

mo re b re a st tissue

RECONSTRUCTION

• I

mpla nt

• Simple r surg e ry
• Usua lly a t le a st two surg e rie s
• Will ne e d a n e xc ha ng e a t so me po int in the future
• Auto lo g o us
• DI

E P, T RAM a nd L a tissimus F la ps

• Muc h b ig g e r surg e ry b ut ma y b e a “o ne a nd do ne ”
• Ag e s with the pa tie nt
• F

e e ls mo re na tura l

SENTINEL LYMPH NODE IN N1 PATIENTS

• Sta nda rd ha s b e e n a c o mple tio n AL

NDx in pa tie nts with N1-2 dise a se pre ne o -a djuva nt c he mo

• Re c e ntly ACOSOG Z1071 lo o ke d a t fa lse ne g a tive

ra te in SL NBx a fte r c he mo

• Sho we d a n a xilla ry pCR in 40% o f pa tie nts
• Sho we d a fa lse ne g a tive ra te o f 12.6%
• F

NR we nt do wn with

• Co mb o o f b lue dye / ra dio tra c e r
• 3 o r mo re lymph no de s re mo ve d

Bo ug he y JC, Suma n VJ, Mitte ndo rf E A, e t a l. Se ntine l lymph no de surg e ry a fte r ne o a djuva nt c he mo the ra py in pa tie nts with no de -po sitive b re a st c a nc e r: the ACOSOG Z1071 (Allia nc e ) c linic a l tria l. JAMA. Oc t 9 2013;310(14):1455-1461

ALLIANCE A11202