Latest Updates

Ductal Carcinoma in Situ (DCIS)

Patricia A Cronin, MD, FRCS, Kimberly J Van Zee, MS, MD, FACS
    • Four prospective RCTs examined the role of RT after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) and found that RT was associated with a circa 50% reduction in local recurrence but no difference in breast cancer–specific mortality or overall survival.
    • In two RCTs, use of adjuvant tamoxifen reduced the risk of local recurrence circa 30% and halved the risk of contralateral breast cancer but did not impact breast cancer–specific mortality or overall survival.
    • Two prospective studies of “low-risk” DCIS treated with BCS alone without RT proved that clinicopathologic characteristics can identify a subgroup at lower risk for recurrence than unselected series;10-year recurrence remained substantial at 12 to 16%.
    • An RCT of RT in “low-risk” patients showed that even in this select subgroup, RT significantly reduced the 7-year recurrence rate.
    • A study-level meta-analysis of 20 studies including almost 8,000 patients resulted in a consensus guideline that recommends 2 mm as an adequate margin in DCIS treated with breast-conserving surgery and RT.
    • Accrual is ongoing into trials of active surveillance without surgery for “low-risk” DCIS. Surgery followed by consideration of adjuvant RT and endocrine therapy remains the standard of care; no subset of DCIS has been identified with minimal risk of progression to invasion without treatment.

Ductal Carcinoma in Situ (DCIS)

Patricia A Cronin, MD, FRCS, Kimberly J Van Zee, MS, MD, FACS
    • Four prospective RCTs examined the role of RT after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) and found that RT was associated with a circa 50% reduction in local recurrence but no difference in breast cancer–specific mortality or overall survival.
    • In two RCTs, use of adjuvant tamoxifen reduced the risk of local recurrence circa 30% and halved the risk of contralateral breast cancer but did not impact breast cancer–specific mortality or overall survival.
    • Two prospective studies of “low-risk” DCIS treated with BCS alone without RT proved that clinicopathologic characteristics can identify a subgroup at lower risk for recurrence than unselected series;10-year recurrence remained substantial at 12 to 16%.
    • An RCT of RT in “low-risk” patients showed that even in this select subgroup, RT significantly reduced the 7-year recurrence rate.
    • A study-level meta-analysis of 20 studies including almost 8,000 patients resulted in a consensus guideline that recommends 2 mm as an adequate margin in DCIS treated with breast-conserving surgery and RT.
    • Accrual is ongoing into trials of active surveillance without surgery for “low-risk” DCIS. Surgery followed by consideration of adjuvant RT and endocrine therapy remains the standard of care; no subset of DCIS has been identified with minimal risk of progression to invasion without treatment.

Lobular Breast Cancer

Tari A King, MD, Anita Mamtani, MD
    • Recognition of invasive lobular cancer as a biologically unique entity from invasive ductal cancer
    • Identification of novel mutations more frequently identified in invasive lobular cancers in The Cancer Genome Analysis (TCGA) study
    • Multimodality treatment approaches with an emphasis on tumor biology
    • Consensus guidelines for negative margins at lumpectomy and applicability to lobular cancers
    • Impact and utility of neoadjuvant chemotherapy and neoadjuvant endocrine therapy in lobular cancers

Understanding the Genetics of Pancreatic Adenocarcinoma

Apoorve Nayyar, MBBS, Post-Doctoral Research Associate,, Jen Jen Yeh, MD
    • Whole genome/exome sequencing
    • RNA expression analysis
    • Genome-wide association studies

Lobular Breast Cancer

Tari A King, MD, Anita Mamtani, MD
    • Recognition of invasive lobular cancer as a biologically unique entity from invasive ductal cancer
    • Identification of novel mutations more frequently identified in invasive lobular cancers in The Cancer Genome Analysis (TCGA) study
    • Multimodality treatment approaches with an emphasis on tumor biology
    • Consensus guidelines for negative margins at lumpectomy and applicability to lobular cancers
    • Impact and utility of neoadjuvant chemotherapy and neoadjuvant endocrine therapy in lobular cancers

Management of Metastatic Sarcoma

Ayana Allard-Picou, MD, Steven C Katz, MD, FACS
    • Advances in targeted therapies for the treatment of metastatic sarcoma, such as imatinib for the management of gastrointestinal stromal tumors.
    • Advances in systemic management, including new combination regimens with traditional agents, as well as novel chemotherapeutic agents
    • Advances in surgical management of sarcoma metastases. Ablation and radioembolization offer alternative methods for management of metastatic lesions in select candidates who are not candidates for surgical resection.

Management of Metastatic Sarcoma

Ayana Allard-Picou, MD, Steven C Katz, MD, FACS
    • Advances in targeted therapies for the treatment of metastatic sarcoma, such as imatinib for the management of gastrointestinal stromal tumors.
    • Advances in systemic management, including new combination regimens with traditional agents, as well as novel chemotherapeutic agents
    • Advances in surgical management of sarcoma metastases. Ablation and radioembolization offer alternative methods for management of metastatic lesions in select candidates who are not candidates for surgical resection.

Understanding the Genetics of Pancreatic Adenocarcinoma

Apoorve Nayyar, MBBS, Post-Doctoral Research Associate,, Jen Jen Yeh, MD
    • Whole genome/exome sequencing
    • RNA expression analysis
    • Genome-wide association studies
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