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Early I-II (TH (BCT (poz RR (subset bez utjecaja (da godine (mlađe od 40Y…

- - - - Bevacizumab
        
        TN
        
        Beatrice
        
        https://www.youtube.com/watch?v=O_WczuK1jcI
        
        https://www.ncbi.nlm.nih.gov/pubmed/23932548
        
        HER
        
        poz
        
        BETH
        
        https://www.youtube.com/watch?v=7pS1xyvJRiU
        
        http://www.ascopost.com/issues/march-15-2014/adding-bevacizumab-to-adjuvant-chemotherapytrastuzumab-fails-to-improve-survival-in-her2-positive-breast-cancer/
        
        neg
        
        E5103
        
        https://www.youtube.com/watch?v=TKieEklvTj0
        
        https://meetinglibrary.asco.org/record/92331/abstract
      - CDK4/6
        
        PALLAS
        
        https://www.youtube.com/watch?v=T94CAgBwMgs
        
        https://clinicaltrials.gov/ct2/show/NCT02513394
      - Bisfpsfpnati
        
        EBCTCG
        
        AZURE, +Zometa
        
        https://www.youtube.com/watch?v=qugSM1YX6hE
        
        http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70302-X/abstract
        
        SWOG0307 (Zom vs or (iba, Klona)
        
        https://www.youtube.com/watch?v=V0kru76-CN8
        
        Z FAST, Zometa +Femara postemono
        
        DENOSUMAB
        
        ABCSG 18, >3000pts, HR.50 rizik fraktura, Deno, 3i pol godine
        
        https://www.youtube.com/watch?v=3QYZ5zw_lCM
        
        D-CARE, neg; adj deno; prem i posmneo
      - Ixabeipole
        
        TN
        
        kemoth
        
        Ixabeipole
        
        TITAN (AC + Tax ili Ix
        
        https://www.youtube.com/watch?v=Xs7fzOrUopc
        
        https://www.ncbi.nlm.nih.gov/pubmed/28508185
  - - - Th 2
        
        Tamoxifen adj
        
        EBCTCG, 5y redukcija smrt 30%
        
        extend
        
        studije
        
        https://www.google.ba/search?q=attom+study+breast&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi7qoHF5-naAhWNxaYKHWNXDngQ_AUICigB&biw=1229&bih=548#imgrc=d_2MCC7NfAyoNM:
        
        extend, ATLAS, 13000 pts
        
        https://www.google.ba/search?q=attom+study+breast&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi7qoHF5-naAhWNxaYKHWNXDngQ_AUICigB&biw=1229&bih=548#imgrc=-RTIVIOoBgq14M:
        
        aTTom
        
        ovarijska ablacija
        
        SOFT-TEXT, 4600 pts,
        
        ABCSG 12, goserelin, Tam vs Anas +/- Zometa
        
        premenopaualno
        
        ZEBRA (CMF+/- Zoladex, OS=
        
        Postmenopauzalne
        
        upfront
        
        ATAC (9300 pts, Tam vs Ana, DFS 0.83 SS)
        
        BIG 1-98 (8000 pts, Tam vs Letr, HR isti gore)
        
        sekvencijski
        
        Tam i AI vs 5y Tam
        
        ABCSG/ARNO 95, 3200 pts, HR 0.80, Anastrazol
        
        IES, Exemestan, HR 0.80
        
        jedan AI vs drugi 5y
        
        MA 27 (eg vs ana) HR 1.02
        
        FACE, (letr vs Anas), HR 0.93
        
        Extend
        
        5yT pa L
        
        M17 (letrozol), B33 (ex)
        
        ABC 16 5y (ta ili AI) pa 2y vs 5 AI
        
        https://www.youtube.com/watch?v=_2deNNZIgEU
        
        sve studije
        
        https://www.google.ba/search?q=attom+study+breast&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi7qoHF5-naAhWNxaYKHWNXDngQ_AUICigB&biw=1229&bih=548#imgrc=C_dPRI_IyesDkM:
        
        ABCSG 16
        
        http://www.ascopost.com/News/58332
        
        DATA
        
        https://www.ncbi.nlm.nih.gov/pubmed/29031778
        
        10y y (Tam pa Letrozol)
        
        Goss, HR 0.66
        
        https://www.youtube.com/watch?v=b0Oucm4z5zo
    - - 1429, 1430
        
        upfront
        
        Sequential; after 2-3 y of TAM
        
        Extended; after 5 y of TAM
    - - premenopauzalne pacijentice
        
        ovarijalna ablacija
        
        reverzibilna inhibicija
        
        mlađe od 40y
        
        koje nisu razvile trajnu amenoreju
        
        studije
        
        Cocrain
        
        LHRH=CMF-u
        
        https://www.ncbi.nlm.nih.gov/pubmed/19821328
        
        meta analiza 2007
        
        < smrtnost
        
        https://www.ncbi.nlm.nih.gov/pubmed/17512856
        
        SOFT-TEXT
        
        AI+LHRH=manje estradiola vs tamoksifen
        
        https://www.nejm.org/doi/full/10.1056/NEJMoa1412379
        
        PROMIS studija
        
        LHRH bolja očuvanost plodnosti
        
        http://ascopubs.org/doi/abs/10.1200/jco.2014.32.26_suppl.105
        
        LHRH vs CMF
        
        ZEBRA
        
        LHRH=CMF pre/perimenopauzalno
        
        https://www.ncbi.nlm.nih.gov/pubmed/12888366
        
        TABLE studija
        
        https://www.ncbi.nlm.nih.gov/pubmed/17577027
        
        LHRH 1vs3 mj
        
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999470/
        
        ASTARRA
        
        Korejska, <1500 pts, pot; Tam+LHRH nako kemoth kod premeno; +DFS
  - - - 5 studija Herc
        
        kardiotoxičnost, 0.6 do 3.5%
        
        N9831/B31
        
        HERA
        
        https://www.youtube.com/watch?v=boK9z1hSasQ
        
        BCIRG 006
        
        https://www.youtube.com/watch?v=IYrCZqVju2Y
        
        Finher
        
        https://www.youtube.com/watch?v=WeZAWWWH7SQ
        
        studije
        
        sve
        
        https://www.google.ba/search?q=adjuvant+herceptin&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjqs-3p2OnaAhUCLZoKHTLcCrsQ_AUICigB&biw=1229&bih=548#imgrc=hOmso6wokLQV1M:
        
        rezultati
        
        https://www.google.ba/search?q=adjuvant+herceptin&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjqs-3p2OnaAhUCLZoKHTLcCrsQ_AUICigB&biw=1229&bih=548#imgrc=PBa64idl2U953M:
        
        trajanje
        
        studije
        
        SHORT-HER
        
        https://www.nejm.org/doi/full/10.1056/NEJMoa1109653
        
        PHARE, non inf, 6 vs 12 mj, neg,
      - Lapatinib
        
        ALTO
        
        https://www.ncbi.nlm.nih.gov/pubmed/23234763
      - pertuzumab
        
        APHINITY, 4800 pts, DFS 0.81 SS, OS nSS
      - Neratinib, ExTENET, 2800 pts, DFS SS
        
        https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30717-9/fulltext
      - APT
        
        https://www.youtube.com/watch?v=at-ZKJPUtj0
    - - pertuzumab
        
        Pertuzumab
        
        APHINITY
        
        https://www.youtube.com/watch?v=0wht5qNJn-A
        
        http://www.nejm.org/doi/full/10.1056/NEJMoa1703643
        
        https://www.google.ba/search?q=aphinity&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi026ry3OnaAhXCIpoKHeWhAHwQ_AUICigB&biw=1229&bih=548#imgrc=yfIWmkNnwV1cUM:
      - trastuzumab
      - TDM1
        
        KAITLIN (TDM1+per vs T+P+Tax)
        
        KATHERINE (T-Tras vs TDM1 rez tm)
        
        https://www.youtube.com/watch?v=O2WavTjVp54
        
        ATTEMPT (3t-t+t vs TDM1)
        
        https://www.youtube.com/watch?v=hBd6ptb7-QA
        
        https://clinicaltrials.gov/ct2/show/NCT01853748
    - - trajanje terapije
        
        presjek studija
        
        https://www.onclive.com/conference-coverage/asco-2018/shorter-trastuzumab-duration-matches-12month-standard-for-early-her2-breast-cancer
        
        studije
        
        6 vs 12 mj; N-
        
        PERSEPHONE
        
        =DFS 4y89%; >4000 pts
        
        PHARE neg neinf
        
        HORG, neg
        
        9tj vs 12 mj
        
        neg neinf
        
        shotHER
        
        SOLD
  - - - kod 75%–80%of
      - LCI vs DCI
    - - data
        
        EBCTCG Oxford meta-analysis
        
        LR po godinama
        
        <40 - 35 vs 60% (+RT vs BCS)
        
        50-60y-15 vs 30%
        
        NSABP B06
        
        1851 pts (flota 851)
        
        (NSABP B06, Milan III, Ontario, Royal Marsdan, EORTC 10801)
    - - absolutne kontrind
      - relative contraindications for BCT
    - - nisu LČ
        
        1do3 LČ
        
        RT axila
        
        više od 4 sve LČ
      - BRCAmutirani
        
        Pierce LJ
        
        IBRT 2x veći
        
        rizik poništen nakon ovariektomije
        
        CBRT 25/40% mut vs 3/7% WT
        
        redukcija za 70% tam
        
        90% tam + ovariekotmiaja
    - - doza
        
        45 do 50Gy
      - boost
        
        EORTC, >5000 ptsl
        
        veći boost NE
        
        https://www.google.ba/search?q=eortc+boost+trial&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj4tOPt27zZAhVHsKQKHR4tCxAQ_AUICigB&biw=1229&bih=607#imgrc=bx7giu1Ari7N-M:
        
        Lyon, 1000 (Tasos otok)
        
        https://www.google.ba/search?q=lyon+boost+trial&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjDrpn_27zZAhWEDuwKHaUODLUQ_AUICigB&biw=1229&bih=607#imgrc=6JOoFuMfOIaaHM:
        
        generalno (kod poz RR, LČ poz, <50 y)
      - RT umjesto op (LČ)
        
        vjrovatno može
        
        https://www.google.ba/search?q=nsabp+b04+breast&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjEz9Sa3LzZAhWBGuwKHXkJALAQ_AUICigB&biw=1229&bih=607#imgrc=n3ZwMACvxOMqCM:
        
        AMAROS
        
        https://www.google.ba/search?q=amaros+study+breast&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjM-ZG93LzZAhWP-6QKHWrDB7AQ_AUICigB&biw=1229&bih=607#imgrc=Xr6zXUjnb0_LSM:
        
        http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70460-7/abstract
    - - reexcizija
      - subset bez utjecaja
        
        da godine
        
        mlađe od 40Y ss RR utjecaj (negLR8% poz 40%)
        
        (Jobsen JJ et al., IJROBP 2003)
        
        https://www.youtube.com/watch?v=UF8uR6Z6KLc
      - T1-2 N0
        
        reex zbog poz RR
        
        RT na CW
        
        Columbia studija
        
        91 pts
        
        50% PORT
        
        1 more item...
      - LR
        
        veći kod poz RR
        
        studija za 50% (12vs28%) i poz LČ
    - - B21
        
        1000p, <1cm, 3 grane: Tam, T+RT, RT-IBRT najbolji u RT+Tam
        
        https://www.google.ba/search?q=nsabp+b21+study&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjBgdDG27zZAhWOCuwKHQsOBm0Q_AUICigB&biw=1229&bih=607#imgrc=NSjiQgy4L1L1gM:
    - - samo BCS i ST (HT)
        
        vjerovatno DA
        
        2 studije-kod >70, tm <1 cm
        
        Princess Margaret Hospital/Canadian trial
        
        LR 1.2 vs 0
        
        CALGB9343/Intergroup trial
        
        LR 7vs1%
        
        još dvije
        
        PRIME II, tm<3 cm, LVI, gr3 da (ne obodvoje), LR 4vs1% (SS)
        
        ABCSG, gr 1-2, T<3cm, LR5vs0.4%
        
        EBCTCG, >70y, +rt LR8% bez RT 16% (BCS)
        
        https://www.youtube.com/watch?v=ddWW6bAMQQc
    - - 45-50Gy
      - boost do 65Gy
      - hypofrakcionirana
        
        START B
        
        T3N1
        
        Whelan, Kanadska
        
        T2N0
        
        nss OS, LC, DFS, kozmetika
      - kad započet
        
        2-4 tj,
        
        ne više od 20 tj pauza
    - - studija B39/RTOG0413
        
        EBRT vs PBI (intersticij, mamasite, ERT)
      - kandidati
      - retro st
        
        dobra kontrola
      - doze
        
        38.5 Gy/10x
        
        34Gy/10x
    - - Upfronoutback studija
        
        bez razlike u ishodu
    - - IMOPRT LOW, 2000 pts (=LC, kozmetika)
        
        http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31145-5/fulltext
  - - - 25% i više
  - - - T3-4N+(>4LČ), RR <1mm
      - NE
        
        margina veća od1 cm
    - - Vancuver, Harvard
        
        (LVSI, grade 3, no chemo, or T2 tumors).
        
        4 faktora 40% vs 0 1%
  - - - ovisi o trimestru
      - 1 trimestar
        
        mastek+AND
      - II-III
        
        neo kemoth
        
        AC i 5FU
        
        OP
  - - - https://www.youtube.com/watch?v=DruO5rHLBQ4
      - http://www.nejm.org/doi/full/10.1056/NEJMoa0806285
    - - http://www.nejm.org/doi/full/10.1056/NEJMoa1412379
    - - https://www.youtube.com/watch?v=b5NjhaG2SbY
      - http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61963-1/abstract
      - recidiv -ČeTKam KaToDu
      - mortaliti- MAMUT RAIST
    - - https://www.youtube.com/watch?v=oBa7bmycnC8
      - http://www.ascopost.com/News/41622
  - - - OncotaypeX
        
        već od T1c (T2-3)
      - iznad 70y bez benefita
    - - LČ poz
- - - - syncytial growth pattern of poorly differentiated
        tumor with a high mitotic rate.
      - Th kao CDI
  - - - stromalna
        
        metastazirat
      - epitelna
    - - recidiv nakon mastektomija a reop morbidnost, kat IIB
    - - reex
  - - - preko ductal epithelium.
        
        infiltriraju epidermis
        
        simptomi crveilo, srbež
        
        u ulceraciju kravarenje
        
        areola
    - - DCI 95%
      - DCIS 10%
  - - - 5-10%
      - contra
        
        30%
        
        sinkroo
        
        metakrono
  - - - contra brest 50%
      - DM 25%
- - - - scintigrafija
- - - - 86vs71 (s boostom)
  - - - 50Gy 5%
      - <50Gy
        
        1%
    - - 1 do70%
  - - - tretirana pleura