Serbian consensus of neoadjuvant therapy for breast cancer: NeoPULSE.

Even though surgery is the primary treatment of operable breast cancer, it has been known for decades that the administration of postoperative adjuvant or preoperative neoadjuvant therapy is extremely important. Indications for neodjuvant therapy administration have been expanded over the years, and nowadays this kind of treatment represents an inevitable option in early breast cancer treatment. The NeoPULSE project, which gathered a group of experts in the field of breast cancer from five Serbian university centres, was formed with the aim to define optimal breast cancer diagnosis, indications for neoadjuvant therapy, therapeutic combinations in relation to molecular/biological parameters of breast cancer, as well as the treatment after neoadjuvant therapy. During two separate expert meetings involving surgeons, medical oncologists, radiation oncologists, a pathologist, and a "Blueprint" workshop, the project participants answered questions over the indications for neoadjuvant therapy. The first part covered local practice and referred to the existence and work of a multidisciplinary team, as well as commonly applied therapeutic regimens in the neoadjuvant setting. Experts analysed personal views regarding indications for the administration and benefits of neoadjuvant therapy, their perception on the correlation between achieving a pathological complete response (pCR) and the outcome of treatment, as well as the attitude towards controversies about this type of treatment, primarily regarding a possible change in the receptor status after therapy and therapeutic options after a suboptimal response. The analysis of the answers pointed to problems and deviations from recommendations in everyday clinical practice, based on which appropriate solutions were proposed. The establishment of such a panel and consensus is an attempt to modernize multidisciplinary teams in Serbia, achieve reaching uniform decisions of all subjects dealing with breast cancer, and therefore, at least in one segment, improve breast cancer treatment in Serbia.

Analysis of sentinel nodes biopsy in breast cancer--12 years after introduction into clinical practice.

INTRODUCTION: Sentinel node biopsy in breast cancer has been a standard procedure at the Institute for Oncology of Vojvodina since 1999 and we have done more than 700 biopsy. Before the introduction of axillary sentinel lymph node biopsy, lymph nodes were routinely dissected, and this approach was the gold standard in surgical treatment of breast cancer. The study was aimed at presenting our results in performing sentinel node biopsy in clinical practice for operative treatment in breast cancer. MATERIAL AND METHODS: All patients (n = 791) were women with clinically T1-2, N0-1, M0 breast cancer. Sentinel lymph node marking was performed by both contrast blue dye (Patentblau V) and radiotracer (antimony sulfide marked with Tc99m). Both contrast media were applied peritumorally or periareolarly. After sentinel lymph node biopsy all patients underwent breast-conserving surgery or mastectomy with or without lymph node dissection of level I and II (depending on sentinel lymph node status). RESULTS: Sentinel lymph node biopsy was negative in 543 (68.7%) patients, and positive in 248 (31.3%) patients. Solitary tumor was present in 722 (91.2%) cases, multifocal tumors in 36 (4.57%), multicentric in 28 (3.55%) and bilateral in 5 (0.68%) patients. The mean duration of follow-up was 60.59 months (median 65, range 12-132). Distant metastases were mostly found in bones (39.13%). CONCLUSION: The number of complications related to axillary dissection can be reduced and the patient's quality of life can be improved by avoiding complete axillary lymph node dissection.

[The value of endorectal ultrasonography in rectal cancer staging].

INTRODUCTION: Preoperative staging of rectal cancer is considered essential to select patients adequately for different therapeutic regimes. The aim of the present study was to evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal cancer. MATERIALS AND METHODS: Fifty rectal cancer patients (31 men, 19 women) underwent endorectal ultrasonography with a 7.5-MHz probe. Thirty-eight of these patients had preoperative chemoradiation and in these patients examination was done before and after the radiotherapy treatment. The results of examinations were compared with the histological findings of the resected specimens. RESULTS: Histopathology showed 4 stage TO, 3 stage T1, 12 stage T2, 30 stage T3, and one stage T4 tumor. Nodal metastases were seen in 17 patients. The overall accuracy of endorectal ultrasonography for determining the depth of invasion (T stage) was 66% (33/50). The accuracy rate of T1 was 100% (1/1), T2 was 45% (9/20), T3 was 79% (22/28), and T4 was 100% (1/1). Overstaging was 18% (9/50) and understaging 16% (8/50). In staging lymph node metastasis, the overall accuracy rate was 70% (18/25) with 18% (9/50) overstaged and 12% (6/50) understaged With regard to nodal involvement, sensitivity was 65% and specificity 73%. Regarding penetration of the rectal wall (stages T1 and T2 vs stages T3 and T4/Dukes' classification A versus B), endorectal sonography showed sensitivity, specificity, and accuracy of 74%, 68%, and 72%, respectively. CONCLUSION: Endorectal ultrasonography is a valuable diagnostic modality for rectal cancer staging. It is fast, safe, accurate, well tolerated by the patient and cheap procedure and therefore should be used as a diagnostic modality of the first choice in rectal cancer staging although one must take into consideration possible limitations in cases of preoperative chemoradiation.