Resource-Stratified Matrix Guidelines

Treatment and Allocation of Resources: Locally Advanced Breast Cancer

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Level of resources Local-regional treatment Systemic treatment (adjuvant)
Surgery
Radiation therapy
Chemo-therapy
Endocrine therapy
Basic

Modified radical mastectomy

 

Neoadjuvant AC, FAC, or classical CMF**

Ovarian ablation

Tamoxifen

Limited
 

Postmastectomy irradiation of the chest wall and regional nodes

   
Enhanced

Breast-conserving therapy*

Breast-conserving whole-breast irradiation

Taxanes

Aromatase inhibitors

LH-RH agonists

Maximal

Reconstructive surgery

 

Growth factors

Dose-dense chemotherapy

 

ABBREVIATIONS: CMF, cyclophosphamide, methotrexate, and 5-fluorouracil; AC, doxorubicin and cyclophosphamide; EC, epirubicin and cyclophosphamide; FAC, 5-fluorouracil, doxorubicin, and cyclophosphamide; and LH-RH, luteinizing hormone–releasing hormone.

* Breast conserving therapy requires mammography and reporting of margin status

** Requires blood chemistry profile and complete blood count (CBC) testing


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