Breast

Question 1

What is the margin for DCIS?

Answer 1

2mm according to Morrow et al 2016 Society of Surgical Oncology recommendation

Question 2

What is the local recurrence rate of DCIS with excision alone?

Answer 2

30% NSABP B-17 study

Question 3

What is Van Nguyen’s prognostic indicator?

Answer 3

For DCIS after BCS
Score 1,2,3
Based on size, margin, pathological classification, age
Low risk is VNPI score of 4-6 where it showed no difference in local recurrence rate with radiotherapy.

Question 4

When should boost be offered to DCIS after BCS?

Answer 4

for non-low-risk DCIS. A boost lowered the 5-year local recurrence rate from 7·3% to 2·9%, resulting in 4% fewer salvage mastectomies compared with the no-boost group; however, this was at the cost of an increase of 15% acute and 11% late grade 2 or more events.

Question 5

What is the local fecurrence

Question 6

What is CTS 5?

Question 7

What is the benefit of adjuvant abrmaciclib in early breast cancer?

Answer 7

Increase in absolute IDFS, DRFS at 4 years
Ki67 remains prognostic but not predictive as abemaciclib is similar regardless of Ki67 index

Question 8

What is the benefit of abemaciclib plus ET compared to ET alone? What is main concerning side effect?

Answer 8

OS data immature
Diarrhoea is significant side effects

Question 9

What is the benefit of adjuvant bisphosphonate?

Answer 9

Cost associated with treatment
Vitamin D as alternative for bone preservation

Question 10

What is the benefit of adjuvant abemaciclib?

Answer 10

HR+, Her2-, node positive, high risk EBC

Question 11

When would you consider omitting adjuvant radiation therapy after lumpectomy?

Answer 11

As per NCCN 2023 guideline
Age > 70
ER+ , pT1pN0 based on CALBG9343
PRIME II and CALGB 9343 did not show an overall survival benefit with adjuvant radiation therapy there was a significant decrease in local breast recurrence

Question 12

What is the local recurrence rate after adjuvant radiation therapy for Stage 1A IDC, ER/PR+, HER2- ?

Answer 12

PRIME II study
10 year local breast recurrence without radiation is 9.5% vs 0.9% with radiation

Question 13

What is the Whelan Trial?

Answer 13

Comparing 50Gy/25# vs 42.5Gy /16#
10 year local recurrence rate were comparable 6.7% vs 6.2%
Cosmetic outcome similar 71.3% vs 69.8%
Subgroup analysis, high grade tumour 10 year LR = 4.7% vs 15.6% (hypofractionation)