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Home:
Meeting
Highlights: 2001
Interactive Report
Section 2: Pre-operative Systemic Therapy
13.
The patient is a 42-year-old woman with a 3 centimeter tumor
in a small breast (volume 250 cc). What treatment would you
recommend?
Neoadjuvant
chemotherapy
Wide excision
Wide excision + mini-flap
Mastectomy
Other |
41%
1%
5%
51%
2%
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Monica Morrow, MD
I am a little bit surprised that so many people went right
to mastectomy, because preoperative chemotherapy is a strategy
that allows breast-conserving surgery in some patients. We can
expand our options beyond simply saying, "I’m sorry,
your tumor is too large for your breast." For someone like
this 42-year-old woman with a 3 centimeter tumor, I could comfortably
say to her, "You are going to receive chemotherapy as part
of your treatment. Whether you have it preoperatively or postoperatively
isn’t going to influence the long-term outcome. If you’re
interested in breast-conserving therapy, this may be a way to
do it."
The other
option here that I think is grossly underutilized is wide
excision and the latissimus mini-flap. This is something that
we employ in patients who do not wish to receive preoperative
chemotherapy or for those who do receive chemotherapy and
still can’t have a cosmetically acceptable lumpectomy.
We have been very pleased with the results.
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14.
The patient is a 50-year-old postmenopausal woman with 4.2
cm, ER+ breast cancer. The tumor is too large to allow breast
conservation, which the patient prefers. Your usual next
treatment would be:
Mastectomy
Chemotherapy
Tamoxifen
Aromatase inhibitor
Radiation therapy
Other |
14%
79%
3%
2%
1%
1%
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15.
The patient is a 75-year-old woman with 4.2 cm, ER+ breast
cancer. The tumor is too large to allow breast conservation,
which the patient prefers. Prior to this meeting, your next
usual treatment would have been:
Mastectomy
Chemotherapy
Tamoxifen
Aromatase inhibitor
Radiation therapy
Other |
24%
41%
6%
27%
1%
1%
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16.
The patient is a 75-year-old woman with 4.2 centimeter, ER+
breast cancer. The tumor is too large to allow breast conservation,
which the patient prefers. Your usual next treatment now would
be:
Mastectomy
Chemotherapy
Tamoxifen
Aromatase inhibitor
Radiation therapy
Other
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9%
16%
3%
71%
1%
1%
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Monica Morrow, MD
In these cases, more of the audience swings towards systemic
therapy, and I find some of the results relatively stunning.
The idea that 41 percent of people would give a receptor-positive
75-year-old woman preoperative chemotherapy to allow breast
preservation — is very surprising.
I’m
not surprised that there is not a lot of use of hormonal
agents to shrink the tumor, because that certainly has not
been a common practice in the United States. I am surprised
that the mastectomy number isn’t higher in the first
case of the 75-year-old, because I think most people would
say to that patient, "Gee, I can’t do breast-conserving
therapy. You’re going to get hormonal therapy postoperatively.
Do you really want to add in chemotherapy just to shrink
this tumor and have a lumpectomy?"
It is
interesting that after looking at the data presented during
this meeting, a significant proportion of the audience said
that they would consider an aromatase inhibitor in this
woman. The corollary to that is that if you give an aromatase
inhibitor in the neoadjuvant setting to allow breast-conserving
therapy, then you also think that it is an acceptable adjuvant
therapy.
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[breast_cancer_symposium/interactive_report2001/backtop.htm]
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