Yip, Cheng Har (2022) De-escalating local treatment for women with breast cancer. Indian Journal Of Surgery, 84 (SUPPL). pp. 611-615. ISSN 0972-2068, DOI https://doi.org/10.1007/s12262-021-03083-8.
Full text not available from this repository.Abstract
De-escalating therapy in breast cancer means doing less to achieve the same outcomes. Surgery to the breast de-escalated from the Halsted radical mastectomy to the modified radical mastectomy, and then to breast-conserving surgery (BCS), which is the current standard of care for early breast cancer. BCS includes a course of radiotherapy, which was de-escalated from a 6-week course to a 3-week course, with a boost to the tumour bed. As the majority of local recurrences occur in the quadrant where the primary tumour was located, a single intraoperative dose of radiotherapy to the cavity at the time of surgery in selected patients was equivalent to whole breast irradiation with a boost to the tumour bed. In tandem with de-escalating surgery to the breast, a full axillary dissection was de-escalated to sentinel lymph node biopsy (SLNB) in clinically node-negative patients. In patients with large tumours where breast conservation is not possible, neoadjuvant systemic therapy (NAST) can safely de-escalate a mastectomy to BCS. NAST can also downstage an axillary node-positive cancer to a node-negative one, so that SLNB can be performed. Lesser surgery will lead to less complications and thus a better quality of life. Current research is focused on treating breast cancer with systemic therapy alone, and selecting out a group of patients where breast or axillary surgery is not required. A major concern of de-escalating surgery is that some women may be undertreated and hence have poorer outcomes. A discussion on the pros and cons of de-escalating surgery is important when offering the choice to women.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | Breast cancer; De-escalation; Local treatment; Outcomes |
| Subjects: | R Medicine > RD Surgery |
| Divisions: | Faculty of Medicine > Surgery Department |
| Depositing User: | Ms Koh Ai Peng |
| Date Deposited: | 16 Jul 2024 02:36 |
| Last Modified: | 16 Jul 2024 02:36 |
| URI: | http://eprints.um.edu.my/id/eprint/46307 |
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