Breast

Question 1

What kind of biopsy is always needed in breast

Answer 1

core biopsy for architectural assessment

Question 2

Management for ADH found at biopsy

Answer 2

Excisional biopsy, you may find DCIS

Question 3

Management of LCIS at biopsy

Answer 3

excisional biopsy, if no ivasive ca or DCIS, no def tx necessary. If pleomorphic moreso

Question 4

ipsi lung constraint for hypofrac breast

Answer 4

V16< 15%, V8 < 40%

Question 5

contralateral lung constraint for hypofrac breast

Answer 5

V4<10%

Question 6

heart constraint for hypofrac breast RT

Answer 6

V16<5%, V8<30%, mean < 3.2 Gy (4)

Question 7

How deep is the max dose of a given electron energy

Answer 7

1/4 of the energy

Question 8

What depth gets 80% of the dose with a given electron energy

Answer 8

1/3 of the energy

Question 9

apbi 30 in 5 lung constraint

Answer 9

V10Gy<15%

Question 10

apbi 30 in 5 heart constraint

Answer 10

V2 Gy < 5%, Max 5 Gy

Question 11

tamoxifen MOA

Answer 11

it’s a SERM, binds to estrogen receptor and blocks estrogen binding, 20 mg qd x 5 years

Question 12

MOA of anastrazole

Answer 12

aromatase inhibitor

Question 13

Pre-menopausal hormone therapy

Answer 13

tamoxifen

Question 14

post-menopausal hormone therapy

Answer 14

anastrazole

Question 15

contraindications to BCT

Answer 15

multicentric, diffuse suspicious microcalcs, persistent + margins, pregnant

Question 16

oncotype cutoff for women<50

Answer 16

16

Question 17

oncotype cutoff for women>50

Answer 17

26

Question 18

pertuzumab is only given in what setting

Answer 18

neoadj

Question 19

what is ddAC-T

Answer 19

Doxo, cyclo, paclitaxel, 60, 600, 80 (doxo cyclo q2w x4) Tx12 q1wk

Question 20

TCHP

Answer 20

trastuzumab, pertuzumab, carbo, docetaxel

Question 21

inferior border of scv field

Answer 21

bottom of clavicular head

Question 22

Comprehensive breast lung constraint

Answer 22

V20<25%, V10<65%

Question 23

Comprehensive breast heart constraint

Answer 23

V25<5%, Mean < 4 Gy, V25<2% for right sided

Question 24

When is PMRT controversial

Answer 24

N1a and T3N0

Question 25

if doing neoadj chemo for cytoreduction, what should you do first

Answer 25

SLNB

Question 26

indications for adj RT after neoadj chemo

Answer 26

cN2+ initially, ypN+, positive margins, lECE, possibly ypN0 if initially N+

Question 27

Do you still do RT after pCR at mastectomy

Answer 27

Yeah for cIII patients

Question 28

who gets additional adjuvant chemo?

Answer 28

TNBC gets xeloda, Herceptin for Her2+

Question 29

Who doesn't get postmastectomy XRT

Answer 29

T1-3N0, T1-2 if only 1-3 LNs, unless they have other risk factors

Question 30

When do you boost after mastectomy

Answer 30

close or postiive margins only

Question 31

workup for IBC

Answer 31

CBC, CMP, alk phos, mammogram, PET/CT, biopsy

Question 32

What is the keynote regimen?

Answer 32

Carboplatin, paclitaxel, pembro, then additional four cycles of pembro and doxorubicin-cyclophosphamide.