d bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
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AdvancedBreastLesionTreatment
DidierBOURGEOIS,MDSurgeryTeamofHenriHartmannBreastInsAtute
Neuilly-Sur-Seine-FRANCE
DefiniAonl StadeIIIUICC
l StadeIIIAl T0,1,2N2M0l T3N1,2M0
l StadeIIIBouT4N0,1,2M0l StadeIIIC
l TxN3M0
l InflammatorydeseaseT4dwometastasis
IntroducAonl 5%metastaAc
l 20–30%chanceofdevelopingmetastasis
l MedianSurvival:30–36month
l 5-yearSurvival:5–10%
Incidencel Geographicvariability
l RareinNorthAmerica&inEurope
l Buthighprevalenceinunderdevelopedcountry
Incidence&Clinicalappearancel Inwelldevelopedcountry:oldwomancancer
l InUnderdevelopedcountry:youngwomancancer
l Wideheterogeneityl Tumoralphenotypel MetastasisevoluAvity
l Notthesametreatment
l NotthesamepronosAc
PronosAcFactors1l PaAent-relatedFactors
l Agel Comorbidity
l Cancer-relatedFactorsl TumoralPhenotypel FreeIntervalwometastasisl Metastasissite:Bones/Visceral/Skin/Nodesl NumberofmetastaAcsitel NumberoflinesofChemotherapy
PredictorsofResponsel HormonalReceptors
l OverexpressionHER2
l ModificaAonsofthesefactorsduringtreatmentl Biopsy+++helptoadjusttreatment
RaAonalityl LocaltreatmentwithsurgeryandradiotherapyisnoteffecAve
l Generaltreatmentwithchemotherapyorhormonotherapy
l TobringthepaAenttothesurgery
Whatkindofgeneraltreatment?l Foragoodlocalresponse,itdependsofthetumoralphenotype
l Hormonalreceptorsl HER2overexpressedl MitosisindexwithKI67
l IldependsoftheageofthepaAent,menopausalstatusandherwellness
LocalyAdvancedCancerofoldwomanl OncogeriatricconsultaAon
l DiscussionwithfamilyandpaAent
l ChemotherapyiftriplenegaAv
l HormonaltreatmentwithfirstorsecondgeneraAonofinhibitorofaromatasel Anastrozole,letrozole,exemestanel Tamoxifenel Fulvestrant
ChemotherapyopAonl Rapidlyprogressivedesease
l Lowprobabilityofresponseofhormonotherapy
l Youngwoman
ChemotherapyopAonl Docetaxel+Capecitabine
l Taxane+Gemcitabine
l 5-FU+Navelbine(Fun)
l HER2+Tumors:CT+trastuzumabl Taxanel Capecitabinel Vinorelbine
LocalyAdvancedCancerofyoungWomanl Chemotherapy
l WithTaxansandcyclophosphamideTACl Withtranstuzumab
l 80%ofgoodandverygoodrespons
l Surgicaltreatmentacceptedwithmastectomy
LocalyAdvancedCancerofyoungWomanl Recurrenceofcancer:2ndlineofchemotherapy
l Dependsondelayofrecurrencel >/<2years
l Maintenancetreatmentwithbevacizumab(opAonnal)
l DuraAonoftreatment?l DeseaseevoluAonl Maximalaccumulateddosel CumulaAvtoxicityl PaAentchoice