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STAGE I - Breast Carcinoma

 
 
STAGE I - BREAST CARCINOMA
THERAPEUTIC OPTIONS
BREAST CARCINOMA - STAGE I
TMN Classification T1, N0,M0
Cell Type All
Description
Tumor Size 0 to 2cm
No Lymph Node Metastasis
No Distant Metastasis

 

LOCAL/SURGICAL MANAGEMENT

 

Therapeutic Option 1: Lumpectomy-Axillary Dissection & Radiation or Lumpectomy - Sentinel Lymphadenectomy & Radiation (45Gy & Electron Boost)
Reference Studies: Fisher B. et al: NSABP:N Engl J Med 320-822, 1989 - Veronesi, U et Al: NCI: Eur J Cancer, 26:668,1990 - Sarrazin et al: IGR: Radiothe. Oncol, 14:177, 1989 - Birchert-Toft, M et al: DBCG: Acta Onc, 27:671, 1988 - Early Breast Cancer Trialist's Collaborative Group: Effect of radiotherapey and surgery in early breast cancer: N Engl J Med 1995;333:1444-55 - Jacobson, J. A et al: Ten year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med, 332-907, 1995
Contrindications: Multicentric Carcinoma
Absolute Must Lumpectomy should be obtained with clear margins status
Average Survival 75 % at 10 years
Disease Free Survival 72 % at 10 years
Therapeutic Comparison Identical Results obtained with Modified Radical Mastectomy
Hospital Stay - Surgery Average: Outpatient
Surgical Statistics
One or two stage - Lumpectomy: Clear margins needed
Axillary Dissection: 10 lymph. nodes minimum preferably
Timing of Radiation Average: 4 weeks after last surgical intervention
Radiation Statistics
Delivery: 45 to 50Gy with Electron Boost
Site of Delivery: Whole Breast
Duration and Timing of Delivery: 5 days a week for 6 weeks
Side Effects: See Radiotherapy for Breast Cancer
Post-operative Protocol -For mammographic malignant lesion: Intra-operative comparison mammogram

-6 months routine post-operative mammogram

 

Therapeutic Option 2: Modified Radical Mastectomy or Total Mastectomy with Sentinel Lymphadenectomy
Reference Studies: Fisher B. et al: NSABP:N Engl J Med 320-822, 1989 - Veronesi, U et Al: NCI: Eur J Cancer, 26:668,1990 - Sarrazin et al: IGR: Radiothe. Oncol, 14:177, 1989 - Birchert-Toft, M et al: DBCG: Acta Onc, 27:671, 1988 - Early Breast Cancer Trialist's Collaborative Group: Effect of radiotherapey and surgery in early breast cancer: N Engl J Med 1995;333:1444-55 - Jacobson, J. A et al: Ten year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med, 332-907, 1995
Contrindications: None
Absolute Indication Multicentric Carcinoma
Average Survival 77 % at 10 years
Disease Free Survival 69 % at 10 years
Therapeutic Comparison Identical Results obtained with Lumpectomy, Axillary Dissection & Radiation
Hospital Stay Average: Outpatient
Surgical Statistics
Axillary Dissection: 10 lymph. nodes minimum preferably

 

SYSTEMIC TREATMENT: CHEMOTHERAPEUTIC - HORMONAL PROTOCOLS

It is essential to assess the ER-PR Receptor Status of these patients and to classify them accordingly.

TUMOR SIZE RECOMMENDATION FOR STAGE I - ER-PR NEGATIVE
0.1 - 1.0 cm NO SYSTEMIC THERAPY
1.0 - 1.99 cm CHEMOTHERAPY RECOMMENDED
RECOMMENDED CHEMOTHERAPEUTIC PROTOCOLS
CLICK ON EACH PROTOCOL
FOR DETAILED INFORMATION
ADRIAMYCIN

CYTOXAN

aka: AC

CYTOXAN

METHOTREXATE

5FU

aka: CMF

ORAL CYTOXAN

METHOTREXATE

5FU

aka: Classic CMF

5FU

ADRIAMYCIN

CYTOXAN

aka: FAC

 

 

TUMOR SIZE RECOMMENDATION FOR STAGE I - ER-PR POSITIVE
0.1 - 1.0 cm NO CHEMOTHERAPY-THERAPY RECOMMENDED

HORMONAL THERAPY MAY BE RECOMMENDED

FOR HIGH RISK PATIENTS (*SEE NOTE)

1.0 - 1.99 cm CHEMOTHERAPY RECOMMENDED

with TAMOXIFEN For 5 Years

RECOMMENDED CHEMOTHERAPEUTIC PROTOCOLS
CLICK ON EACH PROTOCOL
FOR DETAILED INFORMATION
ADRIAMYCIN

CYTOXAN

& TAMOXIFEN

aka: AC-T

CYTOXAN

METHOTREXATE

5FU

& TAMOXIFEN

aka: CMF-T

ORAL CYTOXAN

METHOTREXATE

5FU

& TAMOXIFEN

aka: Classic CMF-T

5FU

ADRIAMYCIN

CYTOXAN

& TAMOXIFEN

aka: FAC-T

*NOTE: Hormonal therapy consisting of Tamoxifen daily for 5 years may be recommended for those patients who despite small tumor size, are at high risk of disease recurrence. Individuals may be divided into "at risk" groups based on, but not limited to, factors such as S-phase, Her-2 neu , ploidy. FOR FURTHER INFORMATION ABOUT HOW PATIENTS ARE ASSIGNED A RISK GROUP SPEAK WITH YOUR PHYSICIAN.

1997 - TransMed Network