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BREAST CONSERVATIVE THERAPY. Dr Shailesh Puntambekar Consulting onco surgeon Associate professor , department of surgery, KEM Hospital, Pune, India. 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.

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Breast conservative therapy
BREAST CONSERVATIVE THERAPY

  • Dr Shailesh Puntambekar

  • Consulting onco surgeon

  • Associate professor , department of surgery, KEM Hospital, Pune, India


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 disease.In the modern era there is no

  • Halstead radical mastectomy

  • Extended radical mastectomy

  • Modified radical mastectomy

  • Breast conservation therapy


Bcs why
BCS:Why? disease.In the modern era there is no

  • 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



Indications
INDICATIONS downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Stage I & II

  • ? Stage III


Contraindications
CONTRAINDICATIONS downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • 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 downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • In a small breast not much to achieve in cosmesis

  • Recurrence comes as Cancer en Cuirasse


Post mrm no radiotherapy
POST MRM NO RADIOTHERAPY downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • SATELLITE NODULES OVER THE CHEST WALL

  • NO TREATMENT IS EFFECTIVE

  • PALIATIVE INTENT OF RADIOTHERAPY


Large breast realities
Large Breast Realities downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • In a large breast recurrences not easily diagnosed

  • A recurrence is viewed as a second primary


Special considerations
SPECIAL CONSIDERATIONS downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Family history

  • Primary tumour histology

  • Margin evaluation

  • Extensive intraductal component


Methods
METHODS downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Lumpectomy +Axillary dissection +RT

  • Lumpectomy+SLN biopsy +RT

  • QUART- Quadrantectomy +Axillary dissection +RT

  • CTART- Chemotherapy +RT


Axillary dissection
Axillary Dissection downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Better control of locoregional recurrence

  • Accurate staging of disease

  • To decide adjuvant therapy

  • Prognosis


Guidelines of surgery
GUIDELINES OF SURGERY downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Incision

  • Technique

  • Closure

  • Axillary Dissection


New investigation modalities
NEW INVESTIGATION MODALITIES downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • MRI

  • Intra-op ultra-sound

  • Touch preparation cytology

  • Percutaneous needle biopsy


New techniques of tumour management
NEW TECHNIQUES OF TUMOUR MANAGEMENT downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Radio Frequency Ablation –RFA

  • Cryosurgery

  • Focused Ultrasound

  • Percutaneous tumour extraction


Role of neoadjuvant
ROLE OF NEOADJUVANT downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Induction chemotherapy

  • Drugs

  • Selection and monitoring of induction chemotherapy patients


Sequencing of chemotherapy and rt
SEQUENCING OF CHEMOTHERAPY AND RT downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • 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 downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Intraoperative radiotherapy

  • Post operative radiotherapy

  • Brachytherapy


Special cases
SPECIAL CASES downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • Hereditory breast cancer

  • Macromastia

  • Occult breast cancer

  • Pregnancy

  • Bilateral breast cancer


Results

BCT / MRM T1 & T2 downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

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 %

RESULTS


Newer frontiers
Newer Frontiers downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.

  • 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 downtrodden Indian woman and signals an end to her married life.The relevance of BCS in the Indian scene cannot be overemphasised.


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