Radiotherapy to the Chest Wall Following Mastectomy for Node-Negative Breast Cancer

Radiotherapy to the Chest Wall Following Mastectomy for Node-Negative Breast Cancer: A Systematic Review
Radiother Oncol. 2009 Apr 1;91(1):23-32, NP Rowell

Trials using inadequate or orthovoltage radiotherapy were excluded. Data linking potential risk factors, either individually or in combination, to the occurrence of LRR(locoregional relapse ) were handled qualitatively. Data from randomised trials of post-mastectomy radiotherapy were included in a meta-analysis.

Results.

Baseline risk of LRR is increased in the presence of

  • lymphovascular invasion
  • grade 3 tumour
  • tumours greater than 2 cm or a close resection margin
  • in patients who are pre-menopausal or aged less than 50.

Those with no risk factors have a baseline risk of LRR of approximately 5% or less rising to a risk of 15% or more for those with two or more risk factors.

In the meta-analysis of three randomised trials of mastectomy and axillary clearance (667 patients), the addition of radiotherapy resulted in an 83% reduction in the risk of LRR (P

Conclusion.

The use of post-mastectomy radiotherapy for women with node-negative breast cancer requires re-evaluation. Radiotherapy should be considered for those with two or more risk factors.

Zhoubný nádor prsu základní charakteristika



STATISTIKA
SVOD Breast

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PATOLOGIE


Histologická klasifikace


Epiteliální maligní nádory prsu

 A.Neinvazivní – ca in situ

  • LCIS – Lobulární ca in situ
  • DCIS -Duktální ca in situ    


  
B.Invazivní

  • Lobulární

            klasický

            alveolární
            solidní
            tubulolobulární
            histiocytoidní
            z prstenčitých buněk

            pleomorfní                 

  • Duktální

             Duktální

             Papilární
             Tubulární
              Mucinózní
              Kribriformní
              Medulární
              Atypický medulární
                 Komedonový
              Apokrinní
              Adenoidně cystický
              Cystický hypersekreční
              Sekreční
              Na glykogen bohatý
              Secernující lipidy
              Karcinom s metaplasií
              Karcinom s endokrinními rysy   


Dělení nádorů podle profilu genové exprese

1) ER pozitivní/HER2 negativní (Luminal A)
2) ER pozitivní/HER2 pozitivní (Luminal B)
3) HER-2 pozitivní/ER negativní
4) ER negativní/HER 2 negativní/EGFR pozitivní a/anebo cytokeratin 5/6 pozitivní (Basal like- typická je vysoká proliferace, vysoký grade a špatná prognóza)
5) ER negativní/HER2 negativní/ EGFR negativní/ cytokeratin 5/6 negativní (Normal like)  


Odkazy:

Zhoubný nádor prsu – novinky

chemotherapy breast cancer – PubMed Results

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Breast cancer – doctorś Guide

Breast cancer – Oncology-Medscape news

NCCN -guidelines

poznámky: 3/2009

  • NCCN 2009: Guidelines for Breast Cancer Updated ( Medscape,Nick Mulcahy,19.3.2009)
  • Changes Regarding Radiation Therapy -…The revision is based in part on a large EORTC study, which indicated that the boost did not provide a significant advantage in preventing recurrence over 8 years for women older than 60 years. However, the advantage was „highly significant“ in women younger than 40, said Dr. McCormick. She also noted there was some advantage to the boost in women aged 41 to 50 years and 51 to 60 years, but it was not as dramatic as it was for the young women. Hence, the guidelines present the boost as optional now, she said…
  • Surgery for Women Who Present With Metastatic Disease….These women may benefit from the performance of local breast surgery and/or radiation therapy…Generally, this palliative local therapy should be considered only after response to initial systemic treatment…..In women who are left with clear margins, this approach doubles the median survival time to about 2 years, compared with 12 months in women who have no surgery.
  • Adjuvant Therapy and Breast Reconstruction
    …In its section on adjuvant chemotherapy, the NCCN’s breast cancer guidelines now rank the therapies. …For women who are not treated with trastuzumab (Herceptin, Genentech) regimens, the preferred regimens are:
    TAC (docetaxel [Taxotere] plus doxorubicin [Adriamycin] plus cyclophosphamide);
    dose-dense AC (doxorubicin plus cyclophosphamide) followed by paclitaxel every 2 weeks;
    TC (docetaxel plus cyclophosphamide);
    AC (doxorubicin plus cyclophosphamide).
    For women who are treated with trastuzumab, the preferred adjuvant regimens are:
    AC (doxorubicin plus cyclophosphamide) followed by T (docetaxel) plus concurrent trastuzumab;
    TCH (docetaxel, carboplatin, trastuzumab)

Zhoubný nádor prsu – chirurgická léčba

zdroj: Chirurgická onkologie H.D.Becker

poznámky:

Všeobecně platné pravidlo je těžko stanovitelné – zohlednění indiv. rizikových faktorů

Jednoznačné rizikové faktory jsou:

  • pozitivní res.okraje a marginální resekce( nádorové buňky v resekčním okraji, popř. v oblasti do 2 mm od resekčního okraje)
  • extenzivní intradukt. komponenta vresekčním okraji
  • věk pacientky nižší než 35 let
  • angiinvaze – krevní a lymfatická

Výsledkem je

  • aby v rámci parc. výkonu Ro min 2mm

A case of Meigs syndrome mimicking metastatic breast carcinoma

Sophocles Lanitis1, Sivahamy Sivakumar1, Kasim Behranwala1,
Emmanouil Zacharakis*2, Ragheed Al Mufti1 and Dimitri J Hadjiminas1,2

Address: 1General Surgery Department, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK and
2Department of Biosurgery and Surgical Technology, Imperial College London 10th Floor, QEQM Wing, St. Mary’s Campus, Praed Street, London,
W2 1NY, UK

Published: 22 January 2009
World Journal of Surgical Oncology 2009, 7:10 doi:10.1186/1477-7819-7-10