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

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

Breast Cancer Education Association October 6, 2018

Evol olution ution of of Br Breast ast Can ancer cer Su Surg rger ery 1890s-1970s Radical Mastectomy Breast Cancer Education Association October 6, 2018

Evol olution ution of of Br Breast ast Can ancer cer Su Surg rger ery 1970s-1990s Modified Rad Mast Breast Cancer Education Association October 6, 2018

Evol olution ution of of Br Breast ast Can ancer cer Su Surg rger ery 1990s-Today Lumpectomy (+RT) Breast Cancer Education Association October 6, 2018

Evol olution ution of of Br Breast ast Can ancer cer Su Surg rger ery 1890s-2000s Axillary Node Dissection Breast Cancer Education Association October 6, 2018

Evol olution ution of of Br Breast ast Can ancer cer Su Surg rger ery 2000s-Today Sentinel Lymph Node (SLN) Breast Cancer Education Association October 6, 2018

Treat reatment ment Toda oday Breast Lump (+RT) Mast (+/- Rec) Surgery Nodes SLN BX Body Hormone Tx Chemotherapy Breast Cancer Education Association October 6, 2018

Treat reatment ment Toda oday Breast Lump (+RT) Mast (+/- Rec) Chemo Nodes SLN BX Body Hormone Tx Chemotherapy Breast Cancer Education Association October 6, 2018

rapy Fi First? st? Ch Chem emothe otherap Advanced Breast Cancer Breast Cancer Education Association October 6, 2018

rapy Fi First? st? Ch Chem emothe otherap Non-Advanced Breast Cancer? Yes! Breast Cancer Education Association October 6, 2018

rapy Fi First? st? Ch Chem emothe otherap Breast Cancer Types ER+ TN HER2+ ER+/PR any /HER2- ER-/PR-/HER2- ER any /PR any /HER2+ Breast Cancer Education Association October 6, 2018

Pre reop op Chem hemothe therap rapy Complete Pathological Response (pCR) ER+ TN HER2+ 11% 38% 45% Boughey Ann Surg 2014 Breast Cancer Education Association October 6, 2018

Su Surviv vival al and and pC pCR TN HER2+ Symmans JCO 2017 Breast Cancer Education Association October 6, 2018

Ca Case se 1 44 y/o ER+/PR+/HER2+ Preoperative Chemo Bilateral Mastectomy pCR Breast Cancer Education Association October 6, 2018

54 y/o Ca Case se 2 6 mm ER-/PR-/HER2- (TN) Preoperative Chemo Lumpectomy + SLN pCR Breast Cancer Education Association October 6, 2018

No Surg No Surger ery? y? Potential Advantages Less pain? Decreased complications? Better cosmetic outcomes? Breast Cancer Education Association October 6, 2018

No Surg No Surger ery? y? Other cancers Esophageal Laryngeal Chemotherapy Anal Radiation Cervical Bre Breast? ast? 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 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 Breast Cancer Education Association October 6, 2018

MD A MD Ande nderson son Fea easibi sibili lity ty Tri rial pCR? Breast Cancer Education Association October 6, 2018

MD A MD Ande nderson son Fea easibi sibili lity ty Tri rial Kuerer Ann Surg 2017 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% Breast Cancer Education Association October 6, 2018

MD MD An Ande derson son 20 2016-00 0046 46 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 Breast Cancer Education Association October 6, 2018

Ne Next xt St Steps eps Ensure safety More feasibility studies Studies comparing: Surgery vs. No Surgery Breast Cancer Education Association October 6, 2018

2018 Breast ast Can ancer cer Treatment atment Wit itho hout ut Surger urgery?! y?! Not Y No t Yet! t! Breast Cancer Education Association October 6, 2018