PowerPoint Slides English European French Translation The Role

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PowerPoint Slides
English
European French Translation
The Role of Surgery in Inflammatory Breast Cancer
Patients
Video Transcript
Pathologie du cancer du sein inflammatoire
Transcription de la vidéo
Professional Oncology Education
The Role of Surgery in Inflammatory Breast Cancer
Patients
Time: 22:38
Formation professionnelle en oncologie
Pathologie du cancer du sein inflammatoire
Durée : 25:34
Anthony Lucci, M.D., F.A.C.S.
Professor of Surgery
Department of Surgical Oncology
The University of Texas MD Anderson Cancer
Center
Savitri Krishnamurthy, Docteur en médecine
Professeur
Service de pathologie
MD Anderson Cancer Center de l'Université du
Texas
Hi, I’m Dr. Anthony Lucci from the University of
Texas MD Anderson Cancer Center in Houston.
And today, I’d like to talk to you about the role of
surgery in inflammatory breast cancer patients.
Bonjour. Je suis le Dr Krishnamurthy, Professeur de
pathologie au MD Anderson Cancer Center de
l'Université du Texas. Je vais vous parler
aujourd'hui de la
pathologie du cancer du sein
inflammatoire.
So, there’s a few learning objectives we will try to
complete. And, the first one will be to determine
the optimal timing and indications for surgery in the
multimodal treatment of patients with inflammatory
breast cancer which, throughout the talk, you’ll see
abbreviated as IBC, capital IBC. We’ll also discuss
optimal surgical treatments for the breast and
regional lymph nodes in patients with IBC. And,
we’ll identify the reconstr
uctive and rehabilitative
issues that occur after surgery in patients with IBC.
Les objectifs de ce programme sont les suivants :
Après avoir suivi cette conférence, les participants
seront capables d'identifier les critères de diagnostic
du cancer du sein inflammatoire, de reconnaître ses
caractéristiques pathologiques au niveau de la peau
et du sein, de comprendre le diagnostic différentiel
du cancer du sein inflammatoire et, enfin, de se
familiariser avec la distribution des biomarqueurs
standards potentiellement utiles pour le carcinome
mammaire inflammatoire. Je commencerai donc
mes explications.

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So, how’s IBC different from regular breast cancer?
I mean, we all know about regular breast cancer,
but how is IBC different? Well, inflammatory breast
cancer has early dissemination, a higher
recurrence rate, and still has a 50 percent mortality
rate. So, even now, with improved treatments,
patients still have about a 50 percent mortality rate
with this disease.
Le carcinome mammaire inflammatoire est un type
de cancer rare et agressif qui représente 1 à 5 % de
l'ensemble des cancers du sein nouvellement
diagnostiqués. Il se caractérise par une progression
rapide, un comportement agressif et une survie
globale inférieure à cel
le des autres cancers du
sein.
Now, treatment planning in IBC is really a key to
success. And, so, in general, the protocol is pretty
simple. Almost all patients with inflammatory
breast cancer need as their primary therapy,
neoadjuvant chemotherapy.
And, then, if the
patient has a response, meaning if the tumor
responds and shrinks either partially or completely,
then it’s been shown that that patient would benefit
from local therapy, such as surgery. Now, breast-
conserving therapy as a surgery option for breast
cancer is well accepted. But, in inflammatory
breast cancer, it’s not optimal, simply due to the
involvement of the skin and surrounding structures,
and the dermal lymphatic invasion with the tumor.
So, breast conservation is not an optimal treatment
option for inflammatory breast cancer and should
not be offered to patients with IBC. As far as
lymph nodes management, we know about sentinel
node biopsies as another real great option for
patients with operable stage I to III breast cancer.
B
ut, not for inflammatory breast cancer because
there are several studies that have shown a high
false-
negative rate in patients with inflammatory
breast cancer. So, generally, these patients will
need an axillary dissection. And, then, following
the surgical therapy, post-mastectomy radiation in
the standard four fields is given, and that’s the
optimal treatment modality currently for
Il se caractérise par un érythème diffus, un œdème
et/ou de la peau d'orange ainsi qu'une éventuelle
sensation de chaleur, avec ou sans masse palpable
au sein. Il est important de souligner que l'érythème
doit couvrir au moins les deux tiers du sein. En
outre, les symptômes cliniques ne doivent pas
remonter à plus de six mois. Enfin, il doit exister une
confirmation pathologique de la présence d'un
carcinome mammaire invasif au niveau du sein
affecté.

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inflammatory breast cancer, the one that offers the
best outcomes.
Now, why even do surgery? Is surgery really going
to help? Well, surgery is important because you
can achieve local control in the majority of patients
if you perform a mastectomy. However, we said
before that surgery would not be perhaps indicated
in all patients suspending ---
depending on the
response to therapy, and we’ll talk a little bit more
about that
in a minute. Also, surgery allows for
pathologic staging after neoadjuvant chemotherapy
because there will be some patients that have a ---
what appears to be a complete clinical response.
But, we will find residual disease at pathologic
evaluation of t
he mastectomy specimen and
perhaps give better prognostic information and
maybe even indications for additional therapy.
And, finally, surgery has been a component of
multimodal therapy that has been shown by
several studies. And, you can see the references
in the bottom right corner of the slide that offer
improved disease-free and overall survival after a
response to neoadjuvant chemotherapy. So,
surgery is an important modality to ---
for the
overall protocol of --- of what we talked about of the
trimodal therapy –
neoadjuvant chemotherapy,
surgery, and then radiation post-
mastectomy to
give the best outcome.
Le carcinome mammaire inflammatoire peut être
divisé en deux entités cliniques
: ce que nous
appelons carcinome mammaire inflammatoire
primair
e et carcinome mammaire inflammatoire
secondaire. Le carcinome mammaire inflammatoire
primaire désigne le développement d'un carcinome
de novo sur un sein auparavant normal. Quant au
carcinome mammaire inflammatoire secondaire, il
désigne l'apparition de c
hangements cutanés
inflammatoires associés à un carcinome mammaire
invasif sur un sein déjà atteint d'un cancer ou au
développement d'un carcinome sur la paroi de la
cage thoracique suite à une mastectomie liée à un
carcinome mammaire non inflammatoire.

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So, we already talked about --- a little bit about
selection, but the best selection criteria are patients
who response to chemotherapy are offered
modified radical mastectomy. And, what we mean
by response is a partial or a complete response to
the che
motherapy, a clinical partial or complete
response.
Plusieurs diagnostics différentiels peuvent
s'appliquer au carcinome mammaire inflammatoire,
notamment une infection bactérienne du sein, telle
qu'une mastite ou une accumulation de pus formant
un abcès
qui pourrait être confondu avec un
carcinome mammaire inflammatoire. D'autres
cancers touchant le sein peuvent également
ressembler au carcinome mammaire inflammatoire.
La dermite post-radique accompagnée de rougeurs
et d'un œdème du sein peut ressembler
énormément au carcinome mammaire
inflammatoire. L'insuffisance cardiaque congestive
avec œdème peut également ressembler au
carcinome mammaire inflammatoire. Pour garantir
la précision du diagnostic, il est donc très important
d'obtenir le plus de détails possibles concernant les
antécédents médicaux de la patiente. Il est
nécessaire, en particulier, d'établir un diagnostic
tissulaire, c'est-à-dire de confirmer la présence d'un
carcinome mammaire dans le sein affecté.
Now, one thing I’d like to point out is that
historically mastectomy alone for inflammatory
breast cancer is a terrible option. And, if you look
at the reason why, surgery alone, this is outcome --
- this slide shows outcome after mastectomy alone
for inflammatory breast cancer. And, we can see
that in general, the outcomes are dismal. So,
when you see here, mean survival in months, after
mastectomy only, the numbers are quite low. In
fact, the total or the medians are right ---
somewhere around 22 months. So, surgery as a
as a --- as a single modality therapy is not
successful and is not recommended.
Le carcinome mammaire inflammatoire se
caractérise par la présence de nombreuses
embolies tumorales dans le corps papillaire et le
derme réticulaire de la peau recouvrant le sein. Ces
embolies sont considérées comme la
caractéristique pathognomonique permettant de
distinguer un carcinome mammaire inflammatoire
d'un carcinome mammaire non inflammatoire.

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Now, one thing surgery is good for in part --- as
part of a combined therapy, is for providing local
control of the disease. And, here we see that when
you look at local regional recurrence after
combined modality therapy, again, systemic
chemotherapy followed by mastectomy, followed
by post-mastectomy radiation, we
have local
regional recurrences somewhere around 20
percent. So, gr---
I think that’s great that in 80
percent of the patients, we can control the local
disease with --- with the use of surgery. So, again,
this is why surgery is an important component of
the treatment of patients with IBC.
Voici un exemple de biopsie cutanée à l'emporte-
pièce pratiquée sur une patiente atteinte d'un
carcinome mammaire inflammatoire. Vous pouvez
observer les nombreuses embolies tumorales
lymphovasculaires au niveau du derme superficiel.
So, how is the surgeon important in diagnosis?
Well, we have to remember that in general,
patients with inflammatory breast cancer will be
often younger aged than those with locally
advanced breast cancer. Now, that’s not all, but
that’s a trend. Also, we have to remember that the
surgeon has a role in rec --- recognizing the signs
of IBC – erythema, edema, which again can cause
the peau d’orange, the characteristic peau
d’orange from the enlargement of the hair follicle
pits. And, we’ll see some pictures of that in just a
second, for a better demonstration. Also, wheals
or ridges in the skin of the breast, and then usually,
that rapid progression of redness covering at least
a third or more of the breast would be criteria ---
diagnostic criteria for inflammatory breast cancer.
Dans le cas du carcinome mammaire inflammatoire,
les embolies tumorales du derme sont
généralement nombreuses et plus grandes que
pour le carcinome mammaire non inflammatoire.
Insistons cependant sur le fait qu'il n'existe pas de
relation directe entre le nombre d'embolies
tumorales lymphovasculaires ou la distension
vasculaire et les manifestations cutanées chez les
patientes atteintes d'un carcinome mammaire
inflammatoire.