TransMed: Stage I IB- Therapeutic Options

Surgical Therapeutic Option 1: Lumpectomy-Axillary Dissection & Radiation - 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

Surgical 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

RECOMMENDATION FOR STAGE IIB LYMPH NODES NEGATIVE or POSITIVE - ER/PR POSITIVE
TMN Classification	T2N0M0 or T3N0M0
Description	Tumor Size Greater than 2 cm Lymph Nodes with of without Disease No Evidence of Distant Spread
Recommendation	CHEMOTHERAPY & HORMONAL THERAPY RECOMMENDED
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
*PATIENTS WITH STAGE IIA LYMPH NODE POSITIVE DISEASE BUT WITH ER/PR NEGATIVE TUMORS ARE TREATED WITH CHEMOTHERAPY BUT DO NOT RECEIVE TAMOXIFEN* *PATIENTS WITH ANY STAGE II DISEASE WITH 4-10 INVOLVED LYMPH NODES MAY BE ELIGIBLE FOR RESEARCH STUDIES* PATIENTS WITH ANY STAGE II DISEASE WITH GREATER THAN 10 LYMPH NODES INVOLVED MAY BE ELIGIBLE FOR RESEARCH STUDIES INCLUDING AUTOLOGOUS STEM CELL TRANSPLANTATION

BREAST CARCINOMA STAGE II B
TMN Classification	T2N1M0 T3N0M0
Cell Type	All
Description	Tumor Size Greater than 2 cm Lymph Node Metastasis or not No Distant Metastasis