Principles of Tx & Prognostic Factors

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Last updated 8:34 PM on 10/3/26
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13 Terms

1
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HER2/neu

  • testing of tissue response to estrogen/progesterone/HER2/neu receptors

  • + receptors respond to hormone therapy & have better outcomes


2
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tx options

  • surgery #1

  • chemo

  • EBRT

  • hormonal therapy


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surgery

  • simple mastectomy - just breast tissue

  • total mastectomy - breast & fascia

  • modified radical mastectomy - fascia, maybe axillary nodes

  • radical mastectomy - pectoral muscles, full axillary dissection

  • extended radical mastectomy - all + IM node dissection


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RT

  • tangents - breast, CW, maybe IM & axillary nodes

  • ant oblique sclav - sup IM node, tail of spence, SC nodes

  • PAB - superior axillary lymph nodes only

  • reduced field boost & e- boost


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event divergence of anterior SC field into tangent

  • prevent match line fibrosis on skin & pulmonary fibrosis

  • split beam on SC field, 90 degree couch kick w. gantry rotation away from tangents, add sup. block on tangent fields, hand blocking divergence on skin


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prevent divergence of PAB

  • increase dose to axilla w. intent to tx nodes/tissue

  • add inf. blocks to match field junction between anterior SC and tangent fields


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bolus

  • inc. skin dose/scar dose

  • low in MV beams

  • breast ca may recur in skin as a nodule or derman lymphatic invasion


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isodose distribution

  • hotspot near nipple, coldspot in area near base of brst

  • wedges used to prevent


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chemotherapy

  • CMF - cyclophosphamide, methotrexate, 5-FU

  • CAF: cyclophosphamide, adriamycin (doxorubicin), 5-FU


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hormonal therapy

  • tamoxifen: anti-estrogen therapy, low toxicity

  • oophorectomy: deproves ovaries of estrogens


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prognostic factors

  • axillary node status

  • size: >4.5cm not candidate for brst conservation

  • age: younger = worse

  • hormone receptor status: inc. survival for ER+

  • stage


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sentinel lymph node biopsy

  • radioactive/ blue dye around tumor site travels through lymph node

  • node tracked by geiger counter, node dissection is performed


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5 year survival rate

  • overall: 89%

  • pos. nodes: 83%

  • regional spread/mets: 20%

  • can relapse 20+ years later!