Management Of The Breast And Axilla In The Neoadjuvant Setting

Over the last several decades breast cancer management has made great strides in the improvement of oncologic treatment outcomes, particularly so in patients with early stage disease. While wide-spread access to screening resulting in early detection is undoubtedly to be credited for this trend, at the same time, the management of breast cancer has evolved to be an intricate multidisciplinary collaboration between breast imagers, surgeons, medical oncologists and radiation oncologist. As a result, with better mutual understanding of multidisplinary goals and challenges, the treatment strategies have become more individualized, with a great emphasis being placed on the intrinsic disease biology. Furthermore, the indications for neoadjuvant systemic therapy have significantly broadened, with a substantial number of patients with early stage breast cancer being able to take advantage of this strategy to decrease the extent of breast surgery they would undergo at its completion. As such, the management of the axilla in these patients has presented with new challenges as well as with new opportunities to scale down on the extent of local therapy and, consequently, its toxicity. This text will provide a comprehensive, state-of-the art review of this field, and will serve as a valuable resource for clinicians (surgeons, medical oncologists, radiation oncologists) and researchers with an interest in breast cancer. The book will review novel and evoling strategies in neoadjuvant systemic therapy forn early stage breast cancer, provide new perspectives about appropriate axillary imaging in anticipation of neoadjuvant systemic therapy, and describe new data on innovative surgical techniques and Radiation Oncology concepts designed to deescalate the extent and toxicity of local therapy while insuring oncologic safety. Several landmark clinical trials have been published in the last few years and will be placed in context with respect to current management. Integration of novel diagnostic and interventional breast imaging, local therapy (surgery and radiation) with contemporary systemic therapy will also be discussed. This text will serve as a very useful resource for physicians and researchers dealing with, and interested in, this challenging field. It will provide a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts. All chapters will be written by experts in their fields and will include the most up to date scientific and clinical information.

In the chapters of this excellent text, the authors have described advances in the neoadjuvant chemotherapeutic management of a number of tumor types. Based on the extensive experience with this management concept in breast cancer, several chapters are devoted to this important topic (Section 1). Section 2 deals with the administration of neoadjuvant chemotherapy in non-breast malignancies. Those who read and study the content of the chapters in this book will come away with a far greater understanding of the rationale supporting neoadjuvant chemotherapy, the existing evidence-based data regarding its use, limitations of the approach, and required future investigative efforts to learn how to optimize the benefits of this innovative management concept.

Despite recent advances in adjuvant therapies of cancer, the regi mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re fined individual approaches to the planning of postoperative adju vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery.

This text is designed to present a comprehensive and state-of the-art approach to the management of breast cancer within the fields of surgery, medical oncology, and radiation oncology. Sections address changes in these fields. These areas include breast imaging, management of the axilla, atypical breast lesions, surgical margins, new techniques in breast reconstruction, and nipple sparing and contralateral mastectomies. Subsequent chapters focus on issues in medical oncology including, triple negative breast cancer and metastatic breast disease. New paradigms in radiation oncology are examined. Breast cancer treatment in the elderly and in young women, and genetic risk in breast cancer management is also be discussed. Written by experts in their field, each of these sections addresses advances and changes in the field. A brief review of the existing literature addressing the particular topic follows in each section. The text concludes with chapters on pathological issues and advances in radiation oncology. As access to a comprehensive multidisciplinary resource such as this is currently limited in the literature, Changing Paradigms in the Management of Breast Cancer represents the first single source to provide information on advances and outcomes for the physician caring for breast cancer patients in a multidisciplinary setting.

This textbook provides a comprehensive overview of the state of the art knowledge of breast cancer management for the modern breast surgeon. It covers all aspects of multidisciplinary care including primary breast and axillary surgery, reconstruction and oncoplastic techniques, external beam radiotherapy and newer techniques such as tomotherapy, intraoperative radiotherapy and brachytherapy. In addition, systemic therapies including chemotherapy, the latest biological targeted therapies and endocrine therapies are covered. Readers can find out about other important aspects of breast cancer such as genetics, screening, imaging and long-term health among others. Chapters take the reader through the basics up to the highest levels of knowledge in an easy to understand format with management algorithms to aid clinical care, generous referencing of the best literature and figures and photographs to illustrate each section. Published with the official approval of the European Society of Surgical Oncology (ESSO) and the European Society of Breast Cancer Specialists (EUSOMA), the book is written by a panel of recognised leaders in the field and is an indispensable guide for the practicing breast specialist and senior specialists in training, wishing to update their knowledge with the latest trends or polish off their training before accreditation.

An intuitive, ingenious and powerful technique, sentinel lymph node biopsy has entered clinical practice with astonishing rapidity and now represents a new standard of care for melanoma and breast cancer patients, while showing great promise for the treatment of urologic, colorectal, gynecologic, and head and neck cancers. This text, written by international experts in the technique, provides a clear and comprehensive guide, presenting a detailed overview and discussing the various mapping techniques available and how these are applied in a number of leading institutions. This essential resource for surgical onocologists, pathologists, and specialists in nuclear medicine will also provide key information for those planning to start a sentinel lymph node program.

This book presents the Proceedings of the Second International Congress on Neo-Adjuvant Chemotherapy which took place on 19 to 21 February 1988 in Paris.

Breast cancer, its causes, early detection and treatment have received considerable attention, since this widespread disease is one of the most important health concerns for women. This book provides a comprehensive overview of the diagnostic and therapeutic aspects of the management of early-stage breast cancer, including essential information on basic topics like pathology, and radiology, as well as the latest developments. Further, it discusses all aspects of surgical care, chemotherapy and radiation therapy, together with the controversies and current management guidelines. Helping readers acquire a deep, holistic understanding of the topic, the book is a valuable resource for practitioners and postgraduate students in the field of gynecologic oncology. Moreover, it is a useful aid to decision-making in day-to-day practice for oncologists, residents, fellows and experienced practitioners.