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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECooperative group research has defined every therapeutic principle for treating early-stage breast cancer over the past 50 years. This article discusses the continuing evolution of surgery and radiation therapy and the beginnings of personalized therapy for patients with breast cancer.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer Genomics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Genomics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERadiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn his introduction to the Education Session, titled \u201c50 Years of Advances in Breast Cancer Treatment: What Have We Learned? Where Are We Going?\u201d presented at the American Society of Clinical Oncology 2014 Annual Meeting, session chair Harold J. Burstein, MD, PhD, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, emphasized that cooperative group research has defined every therapeutic principle for treating early-stage breast cancer over the past 50 years. Speakers in this session described the continuing evolution of surgery and radiation therapy (RT) and the beginnings of personalized therapy for patients with breast cancer.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ELESS SURGERY FOR BREAST CANCER DIAGNOSIS AND TREATMENT\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EKelly Hunt, MD, MD Anderson Cancer Center, Houston, Texas, USA, presented \u201c50 Years of Surgery for Breast Cancer: Doing Less?\u201d Radical mastectomy was the surgical standard of care for over a century before the National Surgical Adjuvant Breast and Bowel Project B-04 trial (NSABP B-04) randomly assigned women with operable breast cancer and clinically positive nodes to radical mastectomy or total mastectomy plus RT and women with clinically negative nodes to one of these treatments or to total mastectomy without RT [Fisher B et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2002]. After 25 years of follow-up, there was no difference in survival among treatments, and women with node-negative breast cancer survived longer than those with node-positive cancer.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThis resulted in total (modified radical) mastectomy\u0027s replacing radical mastectomy as the standard of care. Subsequent trials compared total mastectomy plus axillary lymph node dissection (ALND) against lumpectomy with ALND or lumpectomy with ALND and RT. In a representative trial, NSABP B-06, there was no difference in disease-free survival, distant disease-free survival, or overall survival among treatment groups throughout 25 years of follow-up, indicating that breast conserving treatment is equivalent to mastectomy [Fisher B et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2002].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EALND is still used despite the lack of evidence that it improves survival and its association with serious complications such as lymphedema. Sentinel lymph node dissection (SLND) is more selective, removing only the node or nodes that receive direct lymphatic drainage from the primary tumor site. NSABP B-32 [Krag DN et al. \u003Cem\u003ELancet Oncol\u003C\/em\u003E 2007] showed no differences in overall survival, disease-free survival, or local-regional disease recurrence with SLND only versus SLND plus ALND after 10 years of follow-up [\u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2013; Krag DN et al. \u003Cem\u003ELancet Oncol\u003C\/em\u003E 2010], making SLND the preferred method of axillary evaluation for patients with clinically node-negative disease. Ongoing trials comparing axillary RT with ALND plus RT or evaluating the addition of regional node RT will contribute to the more precise use of surgery on the basis of disease response to therapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EINCREASING IMPORTANCE OF RADIATION THERAPY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EJay R. Harris, MD, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, presented \u201c50 Years of Radiotherapy for Breast Cancer: Doing More?\u201d pointing out that 50 years ago, RT after mastectomy for patients with high-risk disease was so crude that cardiac adverse effects canceled out any potential clinical gains. Now breast-conserving surgery plus RT has become an alternative to mastectomy, with similar rates of local recurrence after 10 years of follow-up, and breast RT plus SLND has become an alternative to ALND. The use of systemic therapy has increased the efficacy and importance of RT by addressing micrometastatic disease.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ERT needs to be safer because irradiation of the heart results in premature ischemic heart disease. A recent case-controlled study showed that major coronary events increased with mean heart dose with no threshold [Darby SC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013]. This risk started within the first 5 years of therapy and continued into the third decade after RT and was greater for those with preexisting cardiac risk factors. Current technology makes it possible to keep the mean heart dose at \u0026lt;1 Gy for almost all those with node-negative disease and \u0026lt;2 Gy for those requiring postmastectomy RT, which should keep the risk low compared with the survival benefit. Hypofractionation of breast RT, in which larger doses are given less often, is being explored for improved patient convenience and cosmetic results, lower rates of local recurrence, and potentially lower cost of therapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPATIENT-TAILORED SYSTEMIC THERAPY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EIn addition to \u201c50 Years of Advances in Breast Cancer Treatment: What Have We Learned? Where Are We Going?\u201d Dr. Burstein also presented \u201c50 Years of Systemic Therapy for Breast Cancer: From One Size Fits All to Tailored Therapy.\u201d Systemic therapy makes local therapy more effective because it reduces local recurrence after breast-conserving surgery and RT; downstages tumors to make breast-conserving surgery feasible; reduces the need for ALND, making SNLD possible; and improves survival after local-regional recurrence. Effective therapy for early breast cancer relies on adjuvant chemotherapy. Advances in therapy have included the use of aromatase inhibitors and tamoxifen to decrease disease recurrence. The discovery of human epidermal receptor 2 (HER2) amplification in some breast cancers resulted in the development of trastuzumab, the first targeted therapy for breast cancer, which has altered the natural history of breast cancer and led to current guidelines recommending HER2 testing for all patients. Since the first reports of the successful use of trastuzumab as adjuvant therapy [Romond et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005], additional targeted therapies addressing HER2 oncogene addiction and driver mutations at different stages of breast cancer have been developed.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDecision making for adjuvant therapy has shifted from a stage- and risk-informed process to one that considers tumor biology, including estrogen receptor and HER2 status.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EEndocrine treatment options have been included in updated American Society of Clinical Oncology guidelines [Burstein HJ et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2014]. For those patients with favorable profiles (ie, HER2 negative, estrogen receptor positive), it remains controversial who should receive chemotherapy, and this will be evaluated in clinical trials.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EDespite the advances in breast cancer therapy, particularly for early-stage disease, and improvements in diagnosis, challenges remain. Among these are finding critical mutations to target, particularly in triple-negative disease, given that known mutations are present only in a minority of tumors; improving on treatment for patients with metastatic disease; providing better palliative care; and caring for patients in the current and evolving health care environment. It will also be challenging to integrate genomic medicine into standard therapy while the era of personalized and precision medicine is still in its infancy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/14\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp58p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}