Wit Without hout Su Surge rgery?! y?! Todd M. Tuttle, MD - - PowerPoint PPT Presentation

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Wit Without hout Su Surge rgery?! y?! Todd M. Tuttle, MD - - PowerPoint PPT Presentation

Oct 03, 2023 472 likes •778 views

Br Brea east st Cancer ancer Tre reatme atment nt Wit Without hout Su Surge rgery?! y?! Todd M. Tuttle, MD University of Minnesota Breast Cancer Education Association October 6, 2018 Di Disclosures sclosures I am a cancer

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Breast Cancer Education Association October 6, 2018

Br Brea east st Cancer ancer Tre reatme atment nt Wit Without hout Su Surge rgery?! y?!

Todd M. Tuttle, MD University of Minnesota

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Breast Cancer Education Association October 6, 2018

Di Disclosures sclosures

  • I am a cancer surgeon
  • I make money by performing cancer operations
  • I make more money by performing big cancer operations
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Breast Cancer Education Association October 6, 2018

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Breast Cancer Education Association October 6, 2018

Evol

  • lution

ution of

  • f Br

Breast ast Can ancer cer Su Surg rger ery

1890s-1970s

Radical Mastectomy

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Breast Cancer Education Association October 6, 2018

Evol

  • lution

ution of

  • f Br

Breast ast Can ancer cer Su Surg rger ery

1970s-1990s

Modified Rad Mast

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Breast Cancer Education Association October 6, 2018

Evol

  • lution

ution of

  • f Br

Breast ast Can ancer cer Su Surg rger ery

1990s-Today

Lumpectomy (+RT)

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Breast Cancer Education Association October 6, 2018

Evol

  • lution

ution of

  • f Br

Breast ast Can ancer cer Su Surg rger ery

1890s-2000s

Axillary Node Dissection

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Breast Cancer Education Association October 6, 2018

Evol

  • lution

ution of

  • f Br

Breast ast Can ancer cer Su Surg rger ery

2000s-Today

Sentinel Lymph Node (SLN)

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Breast Cancer Education Association October 6, 2018

Treat reatment ment Toda

  • day

Surgery

Breast

Lump (+RT) Mast (+/- Rec)

Nodes

SLN BX

Body

Hormone Tx Chemotherapy

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Breast Cancer Education Association October 6, 2018

Treat reatment ment Toda

  • day

Chemo

Breast

Lump (+RT) Mast (+/- Rec)

Nodes

SLN BX

Body

Hormone Tx Chemotherapy

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Breast Cancer Education Association October 6, 2018

Ch Chem emothe

  • therap

rapy Fi

First? st?

Advanced Breast Cancer

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Breast Cancer Education Association October 6, 2018

Ch Chem emothe

  • therap

rapy Fi

First? st?

Non-Advanced Breast Cancer? Yes!

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Breast Cancer Education Association October 6, 2018

Ch Chem emothe

  • therap

rapy Fi

First? st?

Breast Cancer Types ER+

ER+/PRany/HER2-

TN

ER-/PR-/HER2-

HER2+

ERany/PRany/HER2+

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Breast Cancer Education Association October 6, 2018

Pre reop

  • p Chem

hemothe therap rapy

Complete Pathological Response

(pCR)

ER+ 11% TN 38% HER2+ 45%

Boughey Ann Surg 2014

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Breast Cancer Education Association October 6, 2018

Su Surviv vival al and and pC pCR

Symmans JCO 2017

TN HER2+

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Breast Cancer Education Association October 6, 2018

Ca Case se 1

44 y/o ER+/PR+/HER2+ Preoperative Chemo Bilateral Mastectomy

pCR

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Breast Cancer Education Association October 6, 2018

Ca Case se 2

54 y/o 6 mm ER-/PR-/HER2- (TN) Preoperative Chemo Lumpectomy + SLN

pCR

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Breast Cancer Education Association October 6, 2018

No Surg No Surger ery? y?

Potential Advantages

Less pain? Decreased complications? Better cosmetic outcomes?

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Breast Cancer Education Association October 6, 2018

No Surg No Surger ery? y?

Esophageal Laryngeal Anal Cervical

Chemotherapy Radiation

Bre Breast? ast?

Other cancers

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Breast Cancer Education Association October 6, 2018

Pr Previous vious Lim Limita itatio tions ns

Poorly selected groups (ER+/HER2-) Suboptimal imaging No biopsy AFTER preop chemo:

pCR pCR

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Breast Cancer Education Association October 6, 2018

MD A MD Ande nderson son Fea

easibi sibili lity ty Tri rial

Selected groups: TN or HER2+ Preoperative chemotherapy MG and US before and after chemo Core needle bx and removal of original clip Standard surgery

Kuerer Ann Surg 2017

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Breast Cancer Education Association October 6, 2018

MD A MD Ande nderson son Fea

easibi sibili lity ty Tri rial

pCR?

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Breast Cancer Education Association October 6, 2018

MD A MD Ande nderson son Fea

easibi sibili lity ty Tri rial

Kuerer Ann Surg 2017

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Breast Cancer Education Association October 6, 2018

MD A MD Ande nderson son Fea

easibi sibili lity ty Tri rial

40 pts 19 pts (47.5% .5%) had pC pCR

Accuracy:98%

98%

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Breast Cancer Education Association October 6, 2018

MD MD An Ande derson son 20 2016-00 0046 46

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Breast Cancer Education Association October 6, 2018

Ot Other her Fea easib sibility ility Studie Studies

  • Netherlands Cancer institute
  • German Breast Group/University of

Heidelberg

  • UK
  • NRG BR005
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Breast Cancer Education Association October 6, 2018

Ne Next xt St Steps eps

Ensure safety More feasibility studies Studies comparing:

Surgery vs. No Surgery

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Breast Cancer Education Association October 6, 2018

2018 Breast ast Can ancer cer Treatment atment Wit itho hout ut Surger urgery?! y?!

No Not Y t Yet! t!