Devita, Hellman, and Rosenberg's Cancer

LWBK1006-24 LWW-Govindan-Review December 12, 2011 19:15

344 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 24.23. The answer is C.

Skin-sparing mastectomy does not alter the risk of local recurrence. Con-

trary to initial concerns, immediate reconstruction does not alter the risk

of local recurrence, limit ability to detect local recurrence, or delay initia-

tion of systemic therapy. Although fat necrosis, fibrosis, and volume loss

are common with RT after autologous reconstruction, complete flap loss

is rare.

Answer 24.24. The answer is B.

In the ACOSOG Z10 trial, increasing age, body mass index, and surgical

sites with fewer than 50 patients enrolled were associated with a decrease

in sentinel node identification rate.

Answer 24.25. The answer is D.

Pregnancy and lactation are contraindications to SNB. Although T3 and

multicentric tumors were initially thought to be contraindications, recent

data suggest that SNB is accurate in these situations. Although lym-

phedema is less common after SNB than with traditional axillary dis-

section, lymphedema was reported in approximately 5% of patients at

12 months in the ALMANAC trial.

Answer 24.26. The answer is D.

On the basis of the most recent Early Breast Cancer Trialists’ Collabo-

rative Group findings, improved local control at 5 years results in a pro-

portional improvement OS at 15 years. This was true whether improved

local control was obtained by more extensive surgery or the addition of

radiation.

Answer 24.27. The answer is B.

A prognostic factor is defined as a measurement taken at diagnosis that

is associated with outcome. A predictive factor is a measurement that

predicts response or lack of response to a specific therapy. ER is both

prognostic and predictive of benefit from hormonal therapies. The other

factors are prognostic but not predictive.

Answer 24.28. The answer is A.

Adjuvant tamoxifen results in an improvement in OS for at least 15 years.

The benefits are independent of age, menopausal status, and the use of

chemotherapy.

Answer 24.29. The answer is C.

AIs lower estrogen levels by 90% in postmenopausal women. To date,

no study has shown a survival advantage, and the optimal duration of

therapy is unknown. AIs increase the risk of fracture during therapy,

but that risk appears to revert to baseline levels once therapy has been

discontinued.