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(lumpectomy with radiation) and positive sentinel lymph node biopsy. The patients were divided into two groups. Group 1 would complete axillary lymph node dissection, while Group 2 would have no further axillary treatment. Recently the 10 year survival outcomes were published and results showed no significant difference in survival between women undergoing sentinel node surgery alone versus complete axillary node dissection. The study concluded that, in this patient group, removing the rest of the axillary lymph nodes doesn’t improve survival, but it can increase morbidity. Abigail Caudle, M.D., associate professor of Breast Surgical Oncology, and her team have also contributed to de-escalation of axillary surgery for patients who are diagnosed with positive lymph nodes but are scheduled to receive chemotherapy before surgery. Using a technique pioneered at MD Anderson called targeted axillary dissection (TAD), these patients are able to avoid more extensive surgeries and the lymphedema that sometimes accompanies the more extensive procedures. Henry Kuerer, M.D., Ph.D., professor of Breast Surgical Oncology, is involved in an ongoing clinical trial that has demonstrated that some patients may be able to avoid breast surgery altogether when their tumor responds favorably to chemotherapy and targeted treatments. His study utilizes image-guided biopsies to collect samples following chemotherapy treatment that can verify the absence of residual breast cancer in these exceptional responders to therapy. Hunt, Kuerer and colleagues helped to develop the American College of Surgeons ACOSOG Z1071 trial. This NCI-sponsored multicenter trial has led to the development of standards for performance of sentinel lymph node surgery after neoadjuvant chemotherapy in patients who are initially diagnosed with node-positive disease and have a good response to therapy. “You can do less surgery and have the same cancer outcomes when you consider tumor biology and targeted treatments. This has caused a change of practice across the world, and now we’re looking at the same paradigm in women with advanced breast cancer,” Hunt says. Predicting recurrence, improving treatment planning, and overcoming resistance Predicting recurrence, improving treatment planning, and overcoming resistance to therapy are also key research initiatives for the department. Anthony Lucci, M.D., professor, and Carolyn Hall, Ph.D., associate professor of Breast Surgical Oncology use liquid biopsies to track how breast cancer changes over time through the analysis of circulating tumor cells. They have discovered these cells are indicators of recurrence and the mechanisms at the cellular level can drive resistance to chemotherapy and radiation. Hunt and her team were involved with changing the staging system used for breast cancer. They analyzed biomarkers within a tumor to create a more detailed profile of a patient’s risk of recurrence. This staging system was part of the rationale for changing the American Joint Committee on Cancer Staging system for breast cancer, which has now become the standard across the nation and in many other countries. In collaboration with Khandan Keyomarsi, Ph.D., Breast Surgical Oncology professor, Hunt has translated laboratory results from studies of the cell cycle regulator cyclin E, relating to resistance to chemotherapy and endocrine therapy. This biomarker has proven essential to the identification of patients with the greatest risk of recurrence when compared to other prognostic factors, especially in patients with triple-negative breast cancer. These discoveries in the laboratory are fundamental to developing better treatments and improving the lives of our patients. With a nearly $6 million award from CPRIT in September 2018 as a part of a multi-institutional team, Breast Surgical Oncology is poised for further contributions to the lives of patients and to breast cancer research. Division of Surgery | Surgical Outcomes FY18 17 Volumes and Outcomes Multi-team clinic visits for newly diagnosed breast cancer patients Total mastectomies (skin-sparing and nipple-sparing) with breast reconstruction percentage 18 MD Anderson Cancer Center GYNECOLOGIC ONCOLOGY AND REPRODUCTIVE MEDICINE Karen Lu, M.D. Wonderos Department chair Division of Surgery | Surgical Outcomes FY18 19 Our gynecologic oncologists provide world-class comprehensive care of women with gynecologic cancers. They treat: • Ovarian cancer • Uterine cancer • Cervical cancer • Vaginal cancer • Vulva cancer But they don’t simply treat the disease. They introduce and embrace novel therapeutics and advanced surgical techniques to ensure the best outcomes for patients. Some of those treatments include: • Complex ovarian cancer debulking surgery • Sentinel node evaluation for uterine, cervix and vulvar cancers • Fertility-sparing techniques, including radical trachelectomy, a highly specialized procedure that may
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