The Breast : official journal of the European Society of Mastology
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Review Comparative Study
Is there a case for anti-HER2 therapy without chemotherapy in early breast cancer?
Trastuzumab in combination with chemotherapy is now standard of care for patients with early HER2-positive cancers larger than 1 cm. Some patients however may not need or simply may not want chemotherapy with its associated toxicities. For example patients with small (<1 cm. ⋯ In neoadjuvant trials the combination of trastuzumab and pertuzumab without chemotherapy have achieved pathological complete remission rates in a significant minority of patients, suggesting that a subgroup exists for whom anti-HER2 therapy alone may be as effective as with additional chemotherapy. Trials and prospective studies are now warranted to investigate this issue further in selected patients and these must be accompanied by tissue collection to try to identify predictive biomarkers. Meanwhile there is already enough circumstantial evidence to justify anti-HER2 therapy alone in selected patients for whom chemotherapy is contraindicated.
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Review Comparative Study
Patients with anti-HER2 responsive disease: definition and adjuvant therapies.
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The question whether and for whom the gold standard of whole breast radiotherapy (WBRT) may be replaced by accelerated partial breast irradiation (APBI) is one of the most controversial issue in the adjuvant breast cancer setting. Among different APBI techniques, intraoperative radiation therapy (IORT) is particularly appealing to patients and physicians, because the procedure is fast, convenient, normal structures sparing and able to solve some clinical problems, like the integration with chemotherapy. Early findings from phase II and randomized phase III trials show the approach of APBI in selected patients at low risk for local recurrence is safe and well tolerated, but short follow-up creates some reservations. ⋯ Both the American and European Society of Radiology and Oncology provided a consensus statement regarding patient selection criteria based on tumour and patient-related features. The 5-year results of the non-randomized ELIOT study from Milan, using 21 Gy-full dose, identified a group of patients who may be good candidates for the treatment. The stratification of patients according to clinical phenotype or by molecular class and a widespread use of preoperative breast magnetic resonance imaging might be better identify patients eligible for APBI.
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There is a general agreement for immediate breast reconstruction in case of in situ tumors, while the reconstruction is often still delayed in cases of invasive cancers or not performed in the elderly cohort. Aim of this review is to investigate the safety of immediate postmastectomy reconstruction for invasive cancers and in the elderly population. ⋯ Immediate breast reconstruction after mastectomy is an integral part of the complete management of breast cancer. Determining the risk of postmastectomy irradiation prior to definitive resection and reconstructive operations may reduce complications and improve aesthetic outcomes by guiding surgical decision making.
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Oncoplastic surgery (OP) represents a major advance in breast cancer surgery. It is based on three principles: ideal oncology surgery with free margins and adequate local control of disease, immediate breast reconstruction and symmetry, with the transposition of plastic surgery techniques into breast cancer surgery. ⋯ Besides that, it opens to new perspectives of surgical research related to the aesthetic results, quality of life and local control, as well as optimization of operative timing and reduction of both adverse effects and costs. The aim of this review was to present the principles of this approach and the main techniques applied, evaluating its indications and limits in conservative breast cancer surgery.