logging in or signing up pph nee_123 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 444 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: September 16, 2008 This Presentation is Public Favorites: 0 Presentation Description fsfs Comments Posting comment... Premium member Presentation Transcript Breast Conservation Surgery : Breast Conservation Surgery DR Shailesh Puntambekar KEM Hospital Pune These Power Point presentations are free to download only for academic purposes, with due acknowledgements to authors and this website. BREAST CONSERVATIVE THERAPY : BREAST CONSERVATIVE THERAPY Dr Shailesh Puntambekar Consulting onco surgeon Associate professor , department of surgery, KEM Hospital, Pune, India Slide 3: In the good old days we made a clean breast of malignant disease.In the modern era there is no TIT for T(h)AT HISTORY : HISTORY Halstead radical mastectomy Extended radical mastectomy Modified radical mastectomy Breast conservation therapy BCS:Why? : BCS:Why? Ca Breast is a local manifestation of a systemic disease.Local radicality does not change survival Cosmetic Considerations Preservation of the nipple ,an important sensate focus Slide 7: Mastectomy is a socially devastating surgery for the downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised. INDICATIONS : INDICATIONS Stage I & II ? Stage III CONTRAINDICATIONS : CONTRAINDICATIONS Pregnancy Multicentric disease Diffuse indeterminate micro-calcification Previous RT Large tumour/ breast ratio Collagen vascular disease Large breast size Central tumour Small Breast Realities : Small Breast Realities In a small breast not much to achieve in cosmesis Recurrence comes as Cancer en Cuirasse POST MRM NO RADIOTHERAPY : POST MRM NO RADIOTHERAPY SATELLITE NODULES OVER THE CHEST WALL NO TREATMENT IS EFFECTIVE PALIATIVE INTENT OF RADIOTHERAPY Large Breast Realities : Large Breast Realities In a large breast recurrences not easily diagnosed A recurrence is viewed as a second primary SPECIAL CONSIDERATIONS : SPECIAL CONSIDERATIONS Family history Primary tumour histology Margin evaluation Extensive intraductal component METHODS : METHODS Lumpectomy +Axillary dissection +RT Lumpectomy+SLN biopsy +RT QUART- Quadrantectomy +Axillary dissection +RT CTART- Chemotherapy +RT Axillary Dissection : Axillary Dissection Better control of locoregional recurrence Accurate staging of disease To decide adjuvant therapy Prognosis GUIDELINES OF SURGERY : GUIDELINES OF SURGERY Incision Technique Closure Axillary Dissection NEW INVESTIGATION MODALITIES : NEW INVESTIGATION MODALITIES MRI Intra-op ultra-sound Touch preparation cytology Percutaneous needle biopsy NEW TECHNIQUES OF TUMOUR MANAGEMENT : NEW TECHNIQUES OF TUMOUR MANAGEMENT Radio Frequency Ablation –RFA Cryosurgery Focused Ultrasound Percutaneous tumour extraction ROLE OF NEOADJUVANT : ROLE OF NEOADJUVANT Induction chemotherapy Drugs Selection and monitoring of induction chemotherapy patients SEQUENCING OF CHEMOTHERAPY AND RT : SEQUENCING OF CHEMOTHERAPY AND RT 6 Cycles of CMF followed by RT RT followed by 6 cycles of CMF 3 Cycles of CMF followed by RT followed by 3 cycles of CMF (sandwich therapy) RADIOTHERAPY IN BCT : RADIOTHERAPY IN BCT Intraoperative radiotherapy Post operative radiotherapy Brachytherapy SPECIAL CASES : SPECIAL CASES Hereditory breast cancer Macromastia Occult breast cancer Pregnancy Bilateral breast cancer BCS : Procedures : BCS : Procedures Lumpectomy with 2 cm clearance Lumpectomy with Axillary Dissection Quadrantectomy with Axillary Dissection Indications for BCS : Indications for BCS Small/Early Tumors in premenopausal women Lateral than medial tumors More important to know the contraindications Contraindications for BCS : Contraindications for BCS Very small Breast Very large Breast Advanced / High Grade Disease Lactating Breast Multicentricity Disease in opposite Breast RESULTS : RESULTS BCT / MRM T1 & T2 TUMOUR CONTROL RATE 5 YR RELAPSE FREE SURVIVAL RECURRANCE ONLY CONS SURGERY CONS SURGERY + RT 80 TO 90 % 70 TO 88 % 15 TO 40 % 2 TO 10 % Newer Frontiers : Newer Frontiers Laparoscopic Axillary Dissection Laparoscopic Int Mammary Clearance Technically feasible Clearance equal to standard technique Acceptability only after it stands the test of time Thank You : Thank You You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
pph nee_123 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 444 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: September 16, 2008 This Presentation is Public Favorites: 0 Presentation Description fsfs Comments Posting comment... Premium member Presentation Transcript Breast Conservation Surgery : Breast Conservation Surgery DR Shailesh Puntambekar KEM Hospital Pune These Power Point presentations are free to download only for academic purposes, with due acknowledgements to authors and this website. BREAST CONSERVATIVE THERAPY : BREAST CONSERVATIVE THERAPY Dr Shailesh Puntambekar Consulting onco surgeon Associate professor , department of surgery, KEM Hospital, Pune, India Slide 3: In the good old days we made a clean breast of malignant disease.In the modern era there is no TIT for T(h)AT HISTORY : HISTORY Halstead radical mastectomy Extended radical mastectomy Modified radical mastectomy Breast conservation therapy BCS:Why? : BCS:Why? Ca Breast is a local manifestation of a systemic disease.Local radicality does not change survival Cosmetic Considerations Preservation of the nipple ,an important sensate focus Slide 7: Mastectomy is a socially devastating surgery for the downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised. INDICATIONS : INDICATIONS Stage I & II ? Stage III CONTRAINDICATIONS : CONTRAINDICATIONS Pregnancy Multicentric disease Diffuse indeterminate micro-calcification Previous RT Large tumour/ breast ratio Collagen vascular disease Large breast size Central tumour Small Breast Realities : Small Breast Realities In a small breast not much to achieve in cosmesis Recurrence comes as Cancer en Cuirasse POST MRM NO RADIOTHERAPY : POST MRM NO RADIOTHERAPY SATELLITE NODULES OVER THE CHEST WALL NO TREATMENT IS EFFECTIVE PALIATIVE INTENT OF RADIOTHERAPY Large Breast Realities : Large Breast Realities In a large breast recurrences not easily diagnosed A recurrence is viewed as a second primary SPECIAL CONSIDERATIONS : SPECIAL CONSIDERATIONS Family history Primary tumour histology Margin evaluation Extensive intraductal component METHODS : METHODS Lumpectomy +Axillary dissection +RT Lumpectomy+SLN biopsy +RT QUART- Quadrantectomy +Axillary dissection +RT CTART- Chemotherapy +RT Axillary Dissection : Axillary Dissection Better control of locoregional recurrence Accurate staging of disease To decide adjuvant therapy Prognosis GUIDELINES OF SURGERY : GUIDELINES OF SURGERY Incision Technique Closure Axillary Dissection NEW INVESTIGATION MODALITIES : NEW INVESTIGATION MODALITIES MRI Intra-op ultra-sound Touch preparation cytology Percutaneous needle biopsy NEW TECHNIQUES OF TUMOUR MANAGEMENT : NEW TECHNIQUES OF TUMOUR MANAGEMENT Radio Frequency Ablation –RFA Cryosurgery Focused Ultrasound Percutaneous tumour extraction ROLE OF NEOADJUVANT : ROLE OF NEOADJUVANT Induction chemotherapy Drugs Selection and monitoring of induction chemotherapy patients SEQUENCING OF CHEMOTHERAPY AND RT : SEQUENCING OF CHEMOTHERAPY AND RT 6 Cycles of CMF followed by RT RT followed by 6 cycles of CMF 3 Cycles of CMF followed by RT followed by 3 cycles of CMF (sandwich therapy) RADIOTHERAPY IN BCT : RADIOTHERAPY IN BCT Intraoperative radiotherapy Post operative radiotherapy Brachytherapy SPECIAL CASES : SPECIAL CASES Hereditory breast cancer Macromastia Occult breast cancer Pregnancy Bilateral breast cancer BCS : Procedures : BCS : Procedures Lumpectomy with 2 cm clearance Lumpectomy with Axillary Dissection Quadrantectomy with Axillary Dissection Indications for BCS : Indications for BCS Small/Early Tumors in premenopausal women Lateral than medial tumors More important to know the contraindications Contraindications for BCS : Contraindications for BCS Very small Breast Very large Breast Advanced / High Grade Disease Lactating Breast Multicentricity Disease in opposite Breast RESULTS : RESULTS BCT / MRM T1 & T2 TUMOUR CONTROL RATE 5 YR RELAPSE FREE SURVIVAL RECURRANCE ONLY CONS SURGERY CONS SURGERY + RT 80 TO 90 % 70 TO 88 % 15 TO 40 % 2 TO 10 % Newer Frontiers : Newer Frontiers Laparoscopic Axillary Dissection Laparoscopic Int Mammary Clearance Technically feasible Clearance equal to standard technique Acceptability only after it stands the test of time Thank You : Thank You