Publication: Lokal ileri meme kanseri 2010 İstanbul meme kanseri konsensus toplantısı
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Date
2011
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Abstract
Lokal ileri meme kanseri tanımı asıl olarak klinik evre III meme kanserlerini ifade eder. Neoadjuvan kemoterapi (NAKT) cerrahi öncesi yapılan kemoterapi (KT)uygulamasına verilen isimdir. NAKT’de amaç, primer operabl meme kanserlerinde meme koruyucu cerrahi (MKC) şansını arttırmak, inoperabl ve inflamatuvar meme kanserlerinde (İMK) ise operabiliteyi sağlamak ve sağkalımı uzatabilmektir. NAKT öncesi hastanın öykü, fizik inceleme ve evreleme tetkiklerinin tamamlanmış olması gereklidir. Memedeki kitleden kalın iğne biyopsisi yapılmalıdır; bu örnek ER, PR, HER-2 çalışmalarının yapılabilmesi ve arşivleme için yeterli olmalıdır. Primer tümör yatağı işaretlenmelidir. Tedavide antrasiklin ve taksan içeren KT rejimleri, tercihen ardışık olarak ve maksimum tümör yanıtı elde edilene kadar uygulanır. Tedavi yanıtı cerrahi öncesi klinik ve radyolojik olarak, cerrahi sonrası patolojik olarak değerlendirilmelidir. MKC yapılacak olan hastalarda cerrahi, primer tümör yatağını içerecek şekilde yapılmalıdır. İnoperabl ve İMK’de modifiye radikal mastektomi asıl cerrahi yöntemdir. NAKT sonrası sentinel lenf nodu biyopsisi uygulamasının yeri henüz bilinmemektedir. Kemoterapi alması sakıncalı olan veya KT’ yi kabul etmeyen ve hormon reseptörleri (HR) kuvvetli pozitif olan postmenopozal hastalara, neoadjuvan hormonal tedavi önerilebilir. Kemoterapilerini tamamlayan HR pozitif hastalara hormonal tedavi , 5 yıl süreyle, hastanın menopozal durumuna göre seçilerek önerilmelidir. HER-2 pozitif olan tüm hastalara NAKT ile birlikte trastuzumab başlanmalıdır ve cerrahi sonrası da adjuvan olarak devam edilmeli ve 52 haftaya tamamlanmalıdır. Tüm hastalara NAKT yanıtına bakılmaksızın postoperatif dönemde radyoterapi uygulanmalıdır.
The definition of locally advanced breast cancer mainly describes the clinically stage III disease. The aim of neoadjuvant chemotherapy (NACT) is achieving the chance of applying breast-conserving surgery (BCS) in primary operable breast cancer; ensuring the opportunity of operation and prolong the survival in inoperable and inflammatory breast cancer (IBC). The complete staging of the disease should have been completed before the NACT. Tru-cut biopsy of the mass in the breast should be carried out and it should be enough to examine ER, PR and HER-2 status and archive. The place of the primary tumor should be marked before the surgery. As NACT, anthracycline and taxan containing regimens should be applied preferably sequentially until the maximum response can be achieved. The response should be assessed clinically and radiologically before surgery, and pathologically after surgery. BCS should be carried out including the place of the primary tumor. Total mastectomy is the standart operation in inoperable and IBC. Sentinel Lymph Node Biopsy is controversial after NACT. Neoadjuvant hormonal therapy can be used for postmenopausal and hormone-receptor (HR) strongly positive patients who rejected chemotherapy or who is not able to take chemotherapy. After completion of chemotherapy, HR positive patients should receive hormonotherapy, for five years according to the menopausal status. HER-2 positive patients should receive trastuzumab concurrently with NACT and it should be continued after the surgery as a part of adjuvant treatment and completed into total of 52 weeks usage. All patients should receive radiotherapy postoperatively regardless of the response to NACT.
The definition of locally advanced breast cancer mainly describes the clinically stage III disease. The aim of neoadjuvant chemotherapy (NACT) is achieving the chance of applying breast-conserving surgery (BCS) in primary operable breast cancer; ensuring the opportunity of operation and prolong the survival in inoperable and inflammatory breast cancer (IBC). The complete staging of the disease should have been completed before the NACT. Tru-cut biopsy of the mass in the breast should be carried out and it should be enough to examine ER, PR and HER-2 status and archive. The place of the primary tumor should be marked before the surgery. As NACT, anthracycline and taxan containing regimens should be applied preferably sequentially until the maximum response can be achieved. The response should be assessed clinically and radiologically before surgery, and pathologically after surgery. BCS should be carried out including the place of the primary tumor. Total mastectomy is the standart operation in inoperable and IBC. Sentinel Lymph Node Biopsy is controversial after NACT. Neoadjuvant hormonal therapy can be used for postmenopausal and hormone-receptor (HR) strongly positive patients who rejected chemotherapy or who is not able to take chemotherapy. After completion of chemotherapy, HR positive patients should receive hormonotherapy, for five years according to the menopausal status. HER-2 positive patients should receive trastuzumab concurrently with NACT and it should be continued after the surgery as a part of adjuvant treatment and completed into total of 52 weeks usage. All patients should receive radiotherapy postoperatively regardless of the response to NACT.
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Hematoloji, Onkoloji