Breast (new threads)

Axillary Dissection Vs No Axillary Dissection

Sun, 13 Feb 2011 22:15:48 +0000

64/ postmenopausal lady, presented with a lump in right breast. Metastatic Work up negative. Clinically mobile 4cm tumor with no axillary ln. Bx=IDC.
Sx: Lumpectomy with sentinel lymph node dissection done.
HPR: 4.6 cms IDC, Grade 3, NO EIC, LVI focally positive. ER/PR strong positive. Her2 neu Negative. Clear Margins.
LN: 3/4 positive no ECE.

Was sent to us for adjuvant radiation, my teaching was that this lady needs complete axillary ln dissection however things have changed and our breast surgeons do not do it anymore. This publication is an excellent example.
This study is published in full paper form and is ready to be discussed.
http://jama.ama-assn.org/content/305/6/569.full.pdf+html

Please feel free to discuss and tell us how your breast team is handling this issue.

Herceptin : Can we give with radiation?

Sat, 08 Jan 2011 13:15:01 +0000

a 47 yr old Ca breast , post bcs pt is Her 2 neu +ve , post sx she has taken 6 cycles CT(FEC) , it took around 3.5 months .Now she is being planned for RT. but the qs is should we start herceptin along with RT or to wait for RT completion or start herceptin before RT? If we give herceptin first then RT will be delayed further . Is this much gap between SX and RT OK?

Adjuvant treatment in a73 year old patient with ca breast post MRM

Tue, 30 Nov 2010 17:59:53 +0000

A case of infiltrating ductal ca left breast in a 73 year old patient ,operated twice wide excision and which was followed by MRM, HPE - margin negative , grade III, ER + , PR-, Her 2 neu +, LVI +, PNI+, one out of 16 axillary LN + KPS 80, Diabetic , Hypertensive, what should be the adjuvant treatment?

Breast Seed Brachtherapy

Tue, 16 Nov 2010 01:36:03 +0000

I would like the house to comment about Breast Seed Brachytherapy as a treatment modality to do APBI? Any experience/ interest in this treatment option? What does people think about Seed Brachy vs HDR Vs IMRT/3DCRT APBI ?

Breast Conservation in Locally Advanced Breast Cancer

Fri, 10 Sep 2010 23:37:09 +0000

Guys,
For LABC, I was trained with the concept of NACT(3-4 cycles)—-BCS if good response and then complete chemo and RT.
Mastectomy was reserved for patients who had poor response to NACT or if there are other standard contraindications for BCS (mulitfocality, tumor breast ratio, etc.,). However breast surgeons in Canada do not agree to this treatment plan, they do upfront Mastectomy which sounds a bit different than what I learned.

Can anyone tell me do we have strong evidence to support breast conserving therapy in locally advanced breast cancer ? or is this an grey area still?

Nikhilesh

Male Ca Breast with close margins post MRM

Sat, 28 Aug 2010 09:01:54 +0000

60 yr male Ca breast - underwent upfront MRM - size of tumor 4X4.5cms - 20 nodes removed all free; Deep surgical margin is 0.3mm - rest free.
questions:
1) what is the definition of close margin after MRM
2) in the above case what will be the further management. - role of adjuvant radiotherapy - as case is T2N0 post MRM and close margin.

Supraclavicular Radiation

Sun, 22 Aug 2010 18:39:17 +0000

32 year old premenopausal lady had LABC Left Breast. Skin involved. She had axillary node also. She received Neo adjuvant chemotherapy. Following NACT, BCS and axillary dissection was done. All 16 axillary nodes dissected are negative for tumor.
What is the role of Supraclavicular radiation ?

On treatment issue

Wed, 18 Aug 2010 23:04:51 +0000

Guys, we have an ontreatment issue.
49/F, pT2N1 Breast Cancer patient.
Large dense breast, on external beam, conventional tangents, in her 3 rd week has swelling and pain in the treated breast. We tried seroma aspiration, antibiotics, anti-inflammatory meds, good support bra etc., nothing helping, NO CLINICAL recurrence, patient still has pain and edematous breast.
We dont want treatment breaks , any suggestions or ideas ?

Nikhilesh

Risk of recurrencein Breast Ca

Mon, 09 Aug 2010 09:02:34 +0000

I am looking for risk of recurrence in breast Ca according to T stage for Node Neg patients… Not sure where I can find that… From Taghian NSABP review I found Node pos data….

Breast Case #2 (ported from radonc.wikidot)

Sun, 08 Aug 2010 02:34:23 +0000

60 Female Post lumpectomy ;
T2 ( 2.5cm ) ; N0 ; M0
Positive margins
No LVI; No necrosis; ER/PR +; HER2 Neg

Options?

Brast Cancer Case #1 (ported from radonc.wikidot

Sun, 08 Aug 2010 02:32:18 +0000

52 Female. Diagnosed with T4 N1 M0 @ presentation 4 years ago. Treated with Neoadj Chemo + MRM + Adj XRT to chest wall and axilla/scn

Now presents with local chest wall mass. We saw her post resection of the mass by surgeon. + deep margin . Surgeon believes can not remove it by resection.

Re-staging—> No Metastasis.

What would be your treatment options?
If RT? How to deliver to give least chance of XRT necrosis?
What is the chance of soft tissue XRT induced necrosis?
If happens what would be the treatment options?

Side effected of Tamoxifen

Sun, 01 Aug 2010 05:55:20 +0000

52/F, Premenopausal
Early stage breast cancer. pT1No (2cms tumor), IDC, ER/ER positive.
Recd adjuvant AC chemo and Radiation in fall of 2006. Patient receiving Tamoxifen, has bilateral knee pains. Extensively worked up, no other pathology found. Pain related to Tamoxifen. Needs about 4-6 Ibuprofen daily and needs NSAIDS atelast on 5 days in a week.
Socially the lady is involved in strenous work, raises and deals with horses.
Treatment options? Should we discontinue Tamoxifen and start her on any other drug ? Or continue with Tamoxifen and NSAIDS?

How long should a breast cancer patient receive Tamoxifen

Sun, 01 Aug 2010 05:48:47 +0000

Hello need help with this case,
62/F,
pT1pNo (1.2 cms), Infiltrating duct carcinoma, Grade II, ER/PR strongly positive. No LVI/EIC for anyother bad prognostic features.
NO CHEMO. Adjuvant RT to breast, treatment completed in April 2006. Started on Tamoxifen.
Now has bleeding per vaginum. Tamoxifen stopped. Endometrial biopsy - NEGATIVE.
Should this patient receive any other medication or do nothing? Patient cannot afford Arimidex.

Heriditary Breast cancer

Thu, 10 Jun 2010 16:59:48 +0000

Dear all,

I wish to present the case of a 30 yr old lady for your opinion.

She was detected to have a left breast lesion on a mammo done when she presented with complaints of pain left breast. Suspecting a benign lesion a WLE was done which was reported as

Left axillary breast tissue with 2 nodules (0.7 cm each) of invasive ductal carcinoma, Grade 2 - multifocal.
Lymphovascular tumour emboli present.
ER status rich and PR positive.
Hercept test- 0 to 1+.
Margins of specimen are involved by the tumour.

Metastatic work up including a Bone scan was negative.
Opposite breast mammo shows a 4mm lesion ? benign

She has strong family history suggestive of HBOC
The family tree is given below.

Questions:

1. Is there a role of conservation or is mastectomy safer?
2. Role of risk reduction surgery or suggest chemoprevention as she is HR positive
3. In case we do proceed with bilateral mastectomy is there a role for tamoxifen. In such case should we stop it at 5 yrs?
4. What would be the role of salpingo oopherectomy , either prophylactic and or adjuvant?
5. Is BRCA testing required before we proceed, if so should it be a screening for common mutations or full gene sequencing should be done? It will take at least a months from what I have enquired. Can u suggest places where it is done ?
6. Would it be overkill if we do bilateral mastectomy and salpingo oopherectomy considering she may be BRCA positive ?

Dr Balukrishna Sasidharan MD DNB DMRT
Assistant Professor
Dept. of Radiation Oncology- unit I
Christian Medical College Vellore
Tamil Nadu 632004
India
Off: +91 416 228 3145
Mob: 09626262296
fax +91 416 223 2035
moc.liamg|rianulabrd#moc.liamg|rianulabrd
ni.ca.erollevcmc|rianulab#ni.ca.erollevcmc|rianulab

phylloides

Sat, 10 Apr 2010 13:58:03 +0000

malignant phylloides - 11 cms in max dimension - post mastectomy - clear margins - any role for RT?

Post MRM Radiotherapy to the whole axilla

Wed, 07 Apr 2010 11:35:36 +0000

A case of Left LABC underwent Left MRM foolowed by 8 cycles chemotherapy. Pathologically diagnosed as pT2pN3M0, IDC grade III 14 out of 25 nodes positive. systemic work up negative. For post op radiotherapy. Is full axilla ie. including level II & I need to be treated despite adequate lymphnode dissection. Kindly opine and if possible present evidence.

MRI Breast Cancer-COMICE trial

Tue, 02 Mar 2010 05:18:14 +0000

http://www.ncbi.nlm.nih.gov/pubmed/20159292?dopt=Abstract

BCS

Sun, 28 Feb 2010 04:16:21 +0000

ca breast ,idc ,T4 in view of skin involvement.3 NACT then lumpectomy with Axillary dissec done.HPE shows margin clear with 6/20 lymph node positive for malig.pt has completed family .weather to observe her or sent patient for MRM.

supraclav LN

Thu, 25 Feb 2010 13:30:37 +0000

In postmenopausal T4aN3 M0 ladies with supraclav Ln at presentation,post NACT MRM staging ypT2N1M0 ,supraclav recurrence during RT ,should RT continue?Would this still be considered a local recurrence?
An infectious disease during treatment in any patient-chicken pox,herpes,TBetc-how long should the treatment break be - end of infectious period,immediately after taking all due precaution(example with HIV),or after completion of treatment for the infectious disease.

Carcinosarcoma Breast

Tue, 09 Feb 2010 06:36:54 +0000

Carcinosarcoma Breast Left
Initially FNAC revealed Phyllodes Tumor
Lumpectomy was done by Gen Surgeon and it came out Carcinosarcoma with margin Positive T 3.5 X 4 X 3 cm
She underwent MRM as a completion surgery with axillary dissection. All Nodes were negative 0/10 with no residual tumor
Metastatic workup Negative

Comment on adjuvant treatment