RT Book, Section A1 Stephens, Tanya W. A1 Andreopoulou, Eleni A2 Kuerer, Henry M. SR Print(0) ID 6411812 T1 Chapter 36. Systemic Staging and the Radiologic Work-Up of Abnormal Findings T2 Kuerer's Breast Surgical Oncology YR 2010 FD 2010 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-160178-8 LK accesssurgery.mhmedical.com/content.aspx?aid=6411812 RD 2024/03/28 AB Despite important therapeutic innovations within the past several years, the odds of patients with metastatic breast cancer achieving complete response remain extremely low. Judiciously applied multiple endocrine, chemotherapeutic, or biologic therapies attempt to induce a series of remissions and ultimately adequate palliation. Patients with localized breast or chest wall recurrences, however, may be long-term survivors with appropriate therapy. At present, there is a lack of both a consensus management algorithm and an ideal treatment model of specific subsets of women. Before treatment selection for recurrent or metastatic cancer, restaging to evaluate extent of disease is indicated. In the absence of symptomatic disease, the usefulness of a routine diagnostic work-up is not evidence-based. Diagnostic tests and staging procedures are directed by the organ sites most frequently involved in metastatic breast cancer and by patient signs and symptoms. Documentation of initial metastatic sites is helpful in treatment planning and in later assessment of response to treatment. Over the past 45 years, the American Joint Committee on Cancer has regularly updated its staging standards to incorporate advances in prognostic technology.1,2 However, until the development of prognostic indices based on molecular markers are incorporated, Tumor-Node-Metastasis (TNM) staging continues to quantify only the physical extent of the disease. Anatomic staging continues to play a major role in guiding treatment decisions. Clinical decision-making still involves a number of patient and tumor characteristics.3-5 Pretreatment prognostic (measures of tumor burden or hormonal receptor status) and predictive factors (hormonal receptor and HER-2/neu status) are considered in order to select a therapy most likely to benefit patients.6