1 / 20

Theo Wobbes Heelkunde/Chirurgische oncologie UMC St Radboud

Borstsparende behandeling is < 35 jaar onverantwoord. Theo Wobbes Heelkunde/Chirurgische oncologie UMC St Radboud. Waarheid.

yanka
Download Presentation

Theo Wobbes Heelkunde/Chirurgische oncologie UMC St Radboud

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Borstsparende behandeling is < 35 jaar onverantwoord Theo Wobbes Heelkunde/Chirurgische oncologie UMC St Radboud naam/e-mailadres invullen in kop- en voettekst 1

  2. Waarheid At the outset do not be worried about the big question - Truth. It is a very simple matter if each one of you starts with the desire to get as much as possible. No human being is constituted to know the truth, the whole truth, and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition. In this unsatisfied quest the attitude of mind, the desire, the thirst - a third that from the soul must arise - the fervent longing, are to be-all and the end-all. William Osler (1849-1919) 2

  3. Aantal vrouwen in Nederland < 34 jaar met invasief mammacarcinoom 3

  4. Borstkanker op jonge leeftijd 30-40 jaar 6,5% < 30 jaar 1% 4

  5. Borstsparende behandeling Waar gaat het de chirurg om? Dat er geen tumor terug komt op de plek waar hij geweest is!

  6. Borstsparende behandeling Waar gaat het de patiënt om? Dat er in elk geval geen tumor terug komt op de plaats waar de chirurg geweest is!

  7. Waarom is dit huis tegen? AC Voogd et al. J Clin Oncol 2001;19:1688-97 7

  8. Waarom is dit huis tegen? AC Voogd et al. J Clin Oncol 2001;19:1688-97 8

  9. Borstsparende behandeling Recidief in relatie tot leeftijd PHM Elkhuizen et al. Int J Radiation Oncology Biol Phys 1998;40:859-867 9

  10. Women 35 years of age or younger have higher locoregional relapse rates after undergoing breast conservation therapy SH Kim et al. J Am Coll Surg 1998; 187: 94-5 10

  11. How young is young? Oh jl et al. Int J Radiation Oncology Biol Phys 2006; xxx, xx-xx 11

  12. The prognosis of patients with local recurrence more than five years after breast conservation therapy for invasive breast carcinoma MJ van der Sangen et al, Eur J Surg Oncol 2006; 2: 34-8 12

  13. Kans op sterfte en lokaal recidief in relatie tot leeftijd in het NSABP protocol B-06 ER Fisher et al, Cancer 2001; 91:1679-87 Borstsparende behandeling 13

  14. Lokale controle/metastasen op afstand FA Vicini et al. Cancer 2002;97:910-909 A Fortin et al. J Clin Oncol 1999;17:101-109 14

  15. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer AC Voogd et al. Eur J Cancer 2005; 41: 2637-44. 15

  16. Series Ascertainment Genes n MIBC (no.) Risk of MIBC (%) Foulkes et al., 1997[4] Unselected AJ BRCA1 11 2 20 (5-yr) Robson et al., 1998[27] Early-onset AJ BRCA1/2 9 1 NS Verhoog et al., 1998[6] Clinic-based BRCA1 18 NS 14 (5-yr) Gaffney et al., 1998[5] Clinic-based BRCA1/2 7 1 NS Robson et al., 1999[7] Unselected AJ BRCA1/2 35 5    15 (5-yr)22 (10-yr) Haffty et al., 2002[14] Early-onset BRCA1/2 22 11    22 (5-yr) 41 (10-yr) Pierce et al., 2003[9] Clinic-based BRCA1/2 170 12.5 (10-yr) Bremer et al., 2003[15] Hospital-based BRCA1/2 9 (bilateral) 3 29 (5-yr) Delaloge et al., 2003[10] Clinic-based BRCA1/2 37 BRCA116 BRCA2 NS      9 (10-yr)37 (10-yr) Seynaeve et al., 2004[16] Clinic-based BRCA1/2 26 4 NS for BRCA Robson et al., 2004[11] Unselected AJ BRCA1/2 61 NS 12 (10-yr) Metcalfe et al., 2004[12] Clinic-based BRCA1/2 188 NS 11.5 (10-yr) Current study Clinic-based BRCA1/2 95 12 11.2 (5-yr)13.6 (10-yr) Borstsparend bij mutatiedragersRisico van metachroom invasief carcinoom M. Robson et al. Cancer 2005;103:44-51 16

  17. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status Percentage vrouwen zonder lokaal recidief in de ipsilaterale en contralaterale borst verdeeld naar genetische predispositie BG Haffty et al. Lancet 2002;359:1471-77 17

  18. Risico’s van lokaal recidief Lokaal recidief heeft eerste 5 jaren weinig effect op borstkankersterfte Matig, maar duidelijk effect na 15 jaar ! Eén borstkankerdode kan worden voorkomen door vier lokaal recidieven te vermijden !! Geldt voor alle leeftijdsgroepen EBCTCG, Lancet 2005;366:2097-2106 18

  19. Borstsparende operatie Een lokaal recidief is niet een vrijblijvend gebeuren! 19

  20. Waarheid There is no such thing as absolute truth and absolute falsehood. The sientific mind should never recognise the perfect truth or the perfect falshood of any supposed theory or observation. It should carefully weigh the chances of truth and error and grade each in its proper position along the line joining absolute truth and absolute error. Henry August Rowland (1848-1901) Bull Am Phys Soc 1899;1:13 20

More Related