Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Womens Cancer Center, discusses the role of a multidisciplinary team when considering neoadjuvant chemotherapy (NAC) for patients with breast cancer.

King says it is important to understand treatment is very multidisciplinary now, and all members of the team should be involved with decisions upfront. If a patient is considered for NAC, the breast surgeon should determine if that patient will be a candidate for breast conservation before and after treatment. A clip should also be based in the tumor to later identify the tumor bed during treatment, King notes.

Additionally, there needs to be an assessment of the clinical node status, whether the nodes be positive or negative. Imaging must also be done both before and after treatment, using high-quality imaging techniques. All of this will impact surgical recommendations at the completion of NAC, King says. All members of the multidisciplinary team must work together from the beginning to best take advantage of the different areas of expertise, as well as optimize loco regional outcomes for patients with breast cancer.

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Dr. King on Neoadjuvant Chemotherapy in Breast Cancer

Tari King, MD, FACS, chief of Breast Surgery, Brigham Women’s Cancer Center, Dana-Farber Cancer Institute, discusses surgical approaches for patients with breast cancer.

There are a number of factors to take into account when selecting the necessary approach for an individual patient, King says. Along with the size of the tumor and whether or not the disease is in the lymph nodes, it’s important to consider the biology of the tumor. Simply put, this means physicians are looking at hormone receptor status, progesterone receptor status, and HER2 status. These factors all determine a patient’s treatment plan, which is considered when determining a surgical plan. If a patient will derive benefit from chemotherapy, sometimes neodadjuvant chemotherapy will improve outcomes for that patient by downstaging the tumor and leading to a smaller operation. A lumpectomy, for example, would maintain cosmesis of the breast.

King concludes that deciding the right treatment and surgical approach for a patient is still a multidisciplinary approach.

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses surgical approaches in breast cancer.

Dr. King on Surgical Approaches in Breast Cancer

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses approaches to treating lymphedema in patients with breast cancer.

Investigators have been studying the effects of not removing additional lymph nodes in patient with breast cancer. Both observation and axillary radiotherapy have been proven to be effective and have lower rates of lymphedema than axillary node dissection, says King, although many providers prefer to avoid radiation, if possible.

Women who do not have additional surgery do not have to see their physician or undergo extra testing as often as those who do undergo additional surgery, as the rate of axillary recurrence is so low. These patients only require standard surveillance due to this low event rate, says King.

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses approaches to treating lymphedema in patients with breast cancer.
 

Dr. King Discusses Approaches to Lymphedema in Breast Cancer

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses axillary node dissection in patients with breast cancer.

Upfront chemotherapy is being used more often, specifically in patients who have known cancer in the lymph nodes, King says. Chemotherapy is being used before surgery in an effort to eradicate the disease in the lymph nodes. Many of these women are offered sentinel node biopsies, but the technique must be adequate in order to determine whether the node is clean.

King says that with the sentinel node procedure, the field is working toward identifying patients with breast cancer who do not need axillary node dissection. King says that patients who start out with clinically evident biopsy-proven nodal disease who receive chemotherapy upfront may require an axillary node dissection.

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses axillary node dissection in patients with breast cancer.
 

Dr. King Discusses Axillary Node Dissection in Breast Cancer

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses the role of sentinel lymph node biopsy in breast cancer.

Sentinel lymph node biopsy remains an important procedure used in patients with breast cancer, says King, as axillary staging is still needed. There needs to be some assessment if there is cancer in the lymph node, as it can guide treatment, King explains. Steps are being taken to phase out the procedure in some patients.

In the next 10 years, King says that efforts will increase in order to identify which patients do not need to undergo a sentinel lymph node biopsy. There are currently 2 ongoing trials comparing sentinel lymph node biopsy to axillary observation in women who had a normal ultrasound.

Dr. King on Role of Sentinel Lymph Node Biopsy in Breast Cancer

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses lymph node resection in breast cancer.

One of the most feared side effects of breast cancer is lymphedema, says King. Recent data have shown that less surgery spares the morbidity of removing the lymph nodes, without compromising the patients' long-term outcomes.

Data such as these represent the de-escalation of surgical intervention in the treatment of patients with breast cancer, says King.

Tari King, MD, FACS, chief of Breast Surgery, Dana-Farber Cancer Institute, Brigham Women’s Cancer Center, discusses lymph node resection in breast cancer.
 

Tari King, MD, FACS

Articles

Dr. King on Neoadjuvant Chemotherapy in Breast Cancer

Dr. King on Surgical Approaches in Breast Cancer

Dr. King Discusses Approaches to Lymphedema in Breast Cancer

Dr. King Discusses Axillary Node Dissection in Breast Cancer

Dr. King on Role of Sentinel Lymph Node Biopsy in Breast Cancer

Dr. King Discusses Lymph Node Resection in Breast Cancer