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Oncology


Answer 2
  1. Administration of tamoxifen, anthracycline-based chemotherapy, and radiation therapy. Radiation therapy must be performed in conjunction with breast-conserving surgery (eg, lumpectomy) to reduce local and regional recurrences, unless there are contraindications for radiation therapy. The NSABP protocol B-06 study has shown that postoperative radiation therapy reduces the risk for locoregional recurrence from 35% to 10% in patients who undergo lumpectomy and axillary node dissection.2 Systemic adjuvant therapy also is indicated for most invasive breast cancers greater than 1 cm in size. Adjuvant hormonal therapy with 5 years of tamoxifen therapy reduces the odds of recurrence of breast cancer by as much as 50%,3 and chemotherapy reduces the risk by as much as 30%.4 The benefit from these 2 systemic treatment modalities is additive. The most optimal therapy for the case patient should include all 3 treatment modalities.

    REFERENCES
    2. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456–61.

    3. Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet 1998;351:1451–67.

    4. Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet 1998;352:930–42.

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