Evidence Based For invasive breast cancer BCT is Tumor excision, axillary node dissection, whole...
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Transcript of Evidence Based For invasive breast cancer BCT is Tumor excision, axillary node dissection, whole...
Evidence Based
For invasive breast cancerBCT is Tumor excision, axillary node
dissection, whole breast radiationModified mastectomy is total
mastectomy and axillary node dissection
BCT = Modified Mastectomy, in both Recurrence and OS
Recurrence
BCT 1-2%/yr - Recurrence is in-breast, 80 % in primary treated field, 20% new primary or regional
Post mastectomy - Recurrence is chest wall The recurrences are different biologies, and
etiologies The type of recurrence for BCT is eliminated
by mastectomy The type of recurrence for mastectomy is
eliminated by radiation therapy
Recurrence
Since these recurrence “rates” are approximately equal, the treatment successes look the same.
But if you add radiation to mastectomy then there will be a gain in overall survival, i.e. Mastectomy+Rad is superior to BCT, most effect with node positive. Gain of >5% at 15 years.
Radiation
Partial breast radiation Eliminates treatment of “out of field” cancers
known to exist in 20-40% Provides a shell of inadequate therapeutic
radiation ideal for induction of cancer. It should fail to treat each of the distinct risk
issues unique to BCT and Mastectomy Predicts an increase in late failures
Effect of radiotherapy after breast-conserving surgery (10 trials of BCS RT) on local recurrence and on breast cancer mortality
6097 women with node-negative disease
Effect of radiotherapy after breast-conserving surgery (10 trials of BCS RT) on local recurrence and on breast cancer mortality
1214 women with node-positive disease
Effect of radiotherapy after mastectomy and axillary clearance (25 trials of Mast+AC RT) on local recurrence and on breast cancer mortality
1428 women with node-negative disease
Effect of radiotherapy after mastectomy and axillary clearance (25 trials of Mast+AC RT) on local recurrence and on breast cancer mortality
8505 women with node-positive disease
Effect of radiotherapy on breast cancer mortality and on all-cause mortality after mastectomy with axillary clearance (Mast+ACRT)
8505 women with node-positive disease
Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in all women
(9933 women, 86% with node-positive disease)
Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in women with node-negative disease
(1428 women)
Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in all women with node-positive disease
(8505 women, many with the actual number of involved nodes unknown)
Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in women with 1-3 involved lymph nodes (pN1-3)
(1890 women)
Radiotherapy after mastectomy with axillary clearance (Mast+ACRT) in women with 4 or more involved lymph nodes (pN4+)
(1868 women)