By: DrAttai
Mar 18, 2014
Highlights from the 2014 Society of Surgical Oncology Meeting
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And…. welcome to Monday night! #bcsm
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Welcome to the chat everyone! Tonight we’ve got some medical meeting highlights from @SocSurgOnc #SSO2014 #bcsm
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@MikeCowher and @dianeradford – both breast surgeons – attended the meeting and will be sharing their insights #bcsm
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Hello @DrAttai @stales @jodymes. Looking forward to tweeting about #SSO2014. I’m a breast surgeon with @mercysaintlouis #bcsm
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Listening in again – from Ga! #bcsm
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Good evening #bcsm. Matt Katz, radiation oncologist joining a bit late. I hope you’re all well!
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Huge welcome to chat newbies, especially those docs who attended @MikeCowher talk on social media #SSO2014 #bcsm
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Hi to all the lurkers #bcsm
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Thanks…I am a lurker! I attended SSO and Dr. Cowher was nice enough to teach me twitter! #bcsm
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@SocSurgOnc http://surgonc.org covers surgical treatment of all cancers, so only part of the meeting was devoted to breast cancer #bcsm
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Please realize this meeting covered specific topics – we will try to provide highlights #bcsm
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Q1 Margins: big news with the publication in Annals of Surgery 2/10/2014 #bcsm
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Def: Margin: Location of cancer cells in relation to ‘edge’ of cut tissue. positive – at edge. #bcsm
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@DrAttai @MikeCowher @dianeradfordmd Yes, margins have been important for deciding surgery is complete #bcsm
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Adequate margin debated for years. Meta-analysis states “no ink on tumor” is the margin to obtain #bcsm
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what has been debated for years is if there should be a ‘distance’ from closest tumor cell to edge of tissue removed. #bcsm
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@dianeradfordmd @subatomicdoc @stales @DrAttai @ASTRO_org You can access the summary here: http://surgonc.org/margins-study #bcsm #SSO2014
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Not having to go back to re-excise will save not only time, worry etc but about $18M per year healthcare $ #bcsm
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what new guidelines say – for invasive BC (not DCIS), any number / distance of cells between tumor and edge is acceptable #bcsm
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DEFINITION: Ink – when the pathologist gets the tissue from the OR, they use different color inks on the margins – this marks the edge #bcsm
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@machfowlerBC you don’t mark the tumor, you mark the tissue that gets removed.. Path measures tumor distance from ink = margin #bcsm
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picture of inked lumpectomy for those who learn visually: http://commons.wikimedia.org/wiki/File:Inked_Lumpectomy_Specimen_(6464023675).jpg … #bcsm -
But there may still be a role to take more tissue – cases need to be reviewed at multidisciplinary conf with surgeon, rad onc, med onc #bcsm
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So great to have the docs who attended the meeting give us their debrief. Helps to be able to feel part of process. #bcsm
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moving on to T2 – triple negative breast cancer a huge concern – @MikeCowher @dianeradfordmd @Ladysurg: anything new?? #bcsm
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Q2 TNBC, about 40,000 cases USA annually, accounting for 14,000 deaths #bcsm
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T2: data from Cedars Sinai that change what I ‘thought i knew’ – that TNBC is NOT associated with increased risk of nodal mets #bcsm
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Surprising; biology trumps all @MikeCowher T2: data from Cedars Sinai that …TNBC is NOT associated with increased risk of nodal mets #bcsm
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@MikeCowher What are nodal mets? I understand METS but Nodal? #bcsm
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@machfowlerBC def Nodal mets – involved axillary lymph nodes. Not distant (beyond there). #bcsm
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DEFINITION: Nodal mets – when the cancer has spread to the lymph nodes. “mets” commonly refers to other-organ spread bone, liver etc #bcsm
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@hollyejacobs but when in the lymph nodes, we do say “metastatic to lymph nodes”. Metastatic just means spread from the breast #bcsm
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backing up- there is a difference between lymph node metastases and anything beyond that- “metastatic breast cancer pt’ means beyond #bcsm
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DEFINITIONS: BCT = Breast conserving therapy (lumpectomy / radiation) ; LR = Local Recurrence (cancer comes back in the breast) #bcsm
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MT @MikeCowher: T3: Z10 – registry study involving testing bone marrow for tumor cells, then having sentinel biopsy. #bcsm
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t3: z10 cumulative LE incidence subjective 3.7% 1y, 8.9% 3y and 11.9% 5y #bcsm
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t3: objective (arm circumf) LE rates 10.5%, 17.4%, 24.1% #bcsm
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t3: the point: THIS IS MUCH HIGHER THAN OTHER PUBLISHED SERIES OF LE RATES. #bcsm
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YES, we were skeptical @MikeCowher T3
– most I spoke to at #SSO2014 had reservations with such high LE incidence with SLN bx #bcsm -
many other studies (NSABP, etc) show much lower LE rates. many patients in Z10 were lost to follow up. #bcsm
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Q3 usual rates LE with sentinel node bx 3-5%, so 24% is really high #bcsm
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I think imp to mention here: data presented at these meetings is not yet ‘peer reviewed’ for errors in methodology. #bcsm
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so, just because it’s reported doesnt mean it’s gospel! #bcsm
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@MikeCowher Yes, an important caveat for any meeting. More complete vetted answer from publication #bcsm #SSO2014
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umm, what does LE mean? #bcsmvocab #bcsm
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#BCSMVocab RT @DrAttai DEFINITION: LE = lymphedema. Swelling of arm, usually seen after lymph node removal and/or radiation #bcsm
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LE can happen other areas in the body as well – leg, etc – depending on type of cancer / area of both treated #bcsm
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we do measurements before lymph node surgery and then again at 6-8 weeks after #bcsm
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This gives the PT opportunity for education as well #bcsm
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I can’t say it is the new standard but it really helps patients to feel better and gives us numbers to follow #bcsm
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if anyone wants to read EVERY abstract from #sso2014, it’s a free PDF here http://expo.jspargo.com/exhibitor/web/SSO14AbstractBook.pdf … #bcsm
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Last topic T4 – we’re all living thru the increasing role SM plays at medical conferences. @MikeCowher was part of a #SSO2014 panel #bcsm
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T4 – so for the docs – how do you see SM at meetings evolving? #bcsm
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I find SM more and more integrated into conferences – the ‘behind the scenes’ talk is how to do it right… #bcsm
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T4 – and for the patients – what do you want to hear from the medical meetings that will be helpful? #bcsm
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one step is to get publications in the ‘major journals’ regarding the impact of SM. Stay tuned…..mwahahaha. 🙂 #bcsm
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Q4 great topics covered including telemedicine, patient info apps etc #bcsm
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Thanks all for the chance to educate, and thanks @dianeradfordmd and @Ladysurg for the help and camaraderie at #SSO2014. #bcsm
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and thanks to @SocSurgOnc for chiming in as well! #bcsm
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FYI — More on @SocSurgOnc please make sure to check out their site! http://surgonc.org #SSO2014 #bcsm
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And don’t forget — anytime during the week that you need anything, tweet out #BCSM – that’s our bat signal
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