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Theme“Presurgical Treatment of Luminal-
type Breast Cancer”
The Tenth Kyoto Breast Cancer Consensus Conference
Questionnaire Result
Sat. 22 January 2011
Kyoto Breast Cancer Consensus Conference 2011/1/22
CorporatedCorporated institutions for the questionnaire (32 institutions for the questionnaire (32 institutes, no particular order)institutes, no particular order)
Kyoto KatsuraHospital
Shiga University of medical science
Hyogo prefectualTsukaguchi hospital
Shiga medical center for adults
Kohka public hospital
Kan norimichi clinic Otsu red cross hospital
Kyoto min-iren chuohospital
Himeji medical center
Osaka red cross hospital
Japan red cross Wakayama medical center
Obama municipal hospital
Hiroshima university hospital
Kodama surgery
Kitano hospitalKyoto medical center
Kishiwada city hospital
Yamato takadamunicipal hospital
West Kobe medical center
Tenriyorozu hospital
Hikone municipal hospital
Fukui red cross hospital
The Baptist hospital
Prefectural Amagasaki hospital
Nagahama city hospital
Takatsuki red cross hospital
Ako city hospitalKansai electric power hospital
Kurashiki central hospital
Social insurance Shiga hospital
Shinko hospital Kyoto university
Kyoto Breast Cancer Consensus Conference 2011/1/22
Chemotherapy indication of Chemotherapy indication of LuminalLuminal--type breast cancertype breast cancerER levelER level
26
6
PgR levelPgR level
12
19
1
Weigh heavily
Consider
Not Consider
Not measuring
Assessment Assessment methodmethod
27
3
%%
Allred
Kyoto Breast Cancer Consensus Conference 2011/1/22
Chemotherapy indication of Chemotherapy indication of LuminalLuminal--type breast cancertype breast cancer
HER2 levelHER2 level
17
6
9
1810
13
Histological gradeHistological grade
1613
0 3
Nuclear gradeNuclear grade
Weigh heavily
Consider
Not consider
Not measuring
Kyoto Breast Cancer Consensus Conference 2011/1/22
Chemotherapy indication of Chemotherapy indication of LuminalLuminal--type breast cancertype breast cancer
weigh heavily
Consider
Not consider
Not measuring
10
19
3Tumor sizeTumor size
20
12
lymph node involvementlymph node involvement
20
12
Number of involved Number of involved lymph nodeslymph nodes 6
16
10
Level of involved Level of involved lymph nodeslymph nodes
Kyoto Breast Cancer Consensus Conference 2011/1/22
Chemotherapy indication of Chemotherapy indication of LuminalLuminal--type breast cancertype breast cancer
Vascular invasionVascular invasion
8
23
01 1
21
10
Ki67Ki67 11
90
12
Weigh heavily
Consider
Not consider
Not measuring
6
25
1
AgeAge
Histological typeHistological type
Kyoto Breast Cancer Consensus Conference 2011/1/22
OncotypeOncotype DxDx・・MammaPrintMammaPrint
5
27
Using Oncotype Dx
Not using it
Kyoto Breast Cancer Consensus Conference 2011/1/22
Timing of chemotherapyTiming of chemotherapy
9
320
Before surgeryAfter surgeryOn each case
Kyoto Breast Cancer Consensus Conference 2011/1/22
Evaluation of chemotherapeutic Evaluation of chemotherapeutic effects during and after NACeffects during and after NAC
31581719Use3421151Attach particular
importance
Ki67PETCTMRIUSMMG
Kyoto Breast Cancer Consensus Conference 2011/1/22
When hormone receptors become When hormone receptors become negative after prenegative after pre--operative operative chemotherapy, do you give hormonal chemotherapy, do you give hormonal therapy after surgery?therapy after surgery?
20
9
2
GiveNot giveGive when ER before the treatment is high
Kyoto Breast Cancer Consensus Conference 2011/1/22
Do you give preoperative Do you give preoperative hormonal therapy?hormonal therapy?
11
3
18For post-menopausal patientsGive regardless of menopausal statusNot give
Kyoto Breast Cancer Consensus Conference 2011/1/22
The purpose of preoperative The purpose of preoperative hormonal therapy is…hormonal therapy is…
2381To decide the duration of hormonal therapy
15161To obtain pCR
13190To know the change of biomarker (ER, Ki67 etc)
51512Judging the necessity of chemotherapy
4216Tailoring of hormonal therapy
8204Prediction of prognosis
41117To know sensitivity to hormonal therapy
11318Increase in breast conserving rate
Not a purpose
Could well be a purpose
Important purpose
Kyoto Breast Cancer Consensus Conference 2011/1/22
Indication of preoperative Indication of preoperative hormonal therapyhormonal therapy
349Menopausal status
574Low sensitivity to chemotherapy
169Hormonal therapy sensitivity
475Lymph node involvement
1411Tumor size
Not considerConsiderWeigh heavily
Kyoto Breast Cancer Consensus Conference 2011/1/22
Judgment of sensibility to hormonal Judgment of sensibility to hormonal therapytherapy
21245Gene expression profile112136Ki67
7178Age1913histological type
119102vascular invasion2363Level of involved lymph nodes17114Number of involved lymph nodes1688lymph node involvement1796Tumor size
411134Nuclear grade411116Histological grade
14126HER2 level (0, 1+, 2+)51215HER2 (whether positive or
negative)
11120PgR level
131ER level
Not measuringNot considerConsiderWeigh heavily
Kyoto Breast Cancer Consensus Conference 2011/1/22
Evaluation of preoperative hormonal Evaluation of preoperative hormonal therapytherapy
453117Use
23114Attach particular importance
Ki67PETCTMRIUSMMG
2
elasticity
Kyoto Breast Cancer Consensus Conference 2011/1/22
Kyoto Breast Cancer Consensus Conference 2011/1/22
The Tenth Kyoto Breast Cancer Consensus Conference
Theme“Preoperative Treatment of Luminal-type
Breast Cancer”
27%
19%
6%
48% Should be implemented principallyWhen more than 4 then should be implemented principally
Regardless of lymph node meta, it should be decided on propensities of tumor
Not just number of meta but other factors should be taken into account andshould be collectively judged
For hormone receptor positive For hormone receptor positive breast cancer with nodal breast cancer with nodal involvement (>2mm), chemotherapy involvement (>2mm), chemotherapy should be implementedshould be implemented
Kyoto Breast Cancer Consensus Conference 2011/1/22
Chemotherapy should be implemented Chemotherapy should be implemented for hormone receptor positive breast for hormone receptor positive breast cancer with the sizes as stated below, cancer with the sizes as stated below,
13%
9%
15%
63%
More than 2cmMore than 3cmMore than 5cmTumour size is irrelevant
Kyoto Breast Cancer Consensus Conference 2011/1/22
For judging the necessity of For judging the necessity of chemotherapy for hormone receptor chemotherapy for hormone receptor positive breast cancer, PgR is…positive breast cancer, PgR is…
6%
64%
30%
Heavily weighedConsideredNot considered
Kyoto Breast Cancer Consensus Conference 2011/1/22
For judging the necessity of For judging the necessity of chemotherapy for hormone receptor chemotherapy for hormone receptor positive breast cancer, HER2 level (0, 1+, positive breast cancer, HER2 level (0, 1+, 2+) is…2+) is…
0%
49%51%
Heavily weighedConsideredNot considered
Kyoto Breast Cancer Consensus Conference 2011/1/22
Which proliferation marker should Which proliferation marker should be considered for the indication of be considered for the indication of chemotherapychemotherapy
17%
13%
61%
9%
Mitotic index is weighed heavilyKi67 is weighed heavilyJudging collectively Mitotic index, Ki67Proliferation is not taken into consideration
Kyoto Breast Cancer Consensus Conference 2011/1/22
33%
29%
31%
7%
~15%20%30%More than 30%
Kyoto Breast Cancer Consensus Conference 2011/1/22
9%
17%
74%
UsefulNot usefulAbstention
Kyoto Breast Cancer Consensus Conference 2011/1/22
62%
38%
0%
If possible, would like to do it in all casesShould be done with consideration of risk of recurrenceThere is no need to implement at this moment
Kyoto Breast Cancer Consensus Conference 2011/1/22
15%
11%
74%
0%
Useful for prediction of prognosisUseful for prediction of effect of treatment Useful for prediction of prognosis/ prediction of effect of treatmentNot useful
Kyoto Breast Cancer Consensus Conference 2011/1/22
4%
87%
9%
IImportant
Should be considered
Not consider
Kyoto Breast Cancer Consensus Conference 2011/1/22
83%
0%
13%
4%
GiveNot giveDepend on hormone receptor levelbefore chemotherapy
Others
If the hormone receptor became negative (0%) after preoperative chemotherapy, would you give hormonal therapy after surgery?
Kyoto Breast Cancer Consensus Conference 2011/1/22
33%
21%
41%
5%
For postmenopausal patients
Give regardless of menopausal status
Not give, but would like to
Would not like to give
Kyoto Breast Cancer Consensus Conference 2011/1/22
To know the sensitivity of hormonal To know the sensitivity of hormonal treatment can be the purpose of treatment can be the purpose of preoperative hormonal therapy?preoperative hormonal therapy?
84%
2%
14%
Can be purposeCan’t be purposeCan’t say either
Kyoto Breast Cancer Consensus Conference 2011/1/22
Preoperative hormonal therapy should Preoperative hormonal therapy should be given only for the highly hormone be given only for the highly hormone sensitive breast cancer?sensitive breast cancer?
46%
32%
22%
I think soI don’t think soabstention
Kyoto Breast Cancer Consensus Conference 2011/1/22
37%
5%
58%
I think soI don’t think soabstention
Kyoto Breast Cancer Consensus Conference 2011/1/22
47%
40%
10%3%
Size reduction is necessary
SUV decrease by FDG-PET or decrease of Ki67
Change of solidity of tumour
Others
Kyoto Breast Cancer Consensus Conference 2011/1/22
For the evaluation of treatment For the evaluation of treatment effect, are you interested in effect, are you interested in Volumetry?Volumetry?
96%
0% 4% 0%
InterestedNot interestedMore info is necessaryOthers
Kyoto Breast Cancer Consensus Conference 2011/1/22
Are you interested in clinical trial Are you interested in clinical trial using Volumetry?using Volumetry?
87%
11%
2%
Interested
Not interested
Abstention
Kyoto Breast Cancer Consensus Conference 2011/1/22