e17526 Background: For locally advanced breast cancer patients (LABC), there are currently limited, if any, up-to-date protocol guidelines. The objective of this paper was to develop a consensus of opinion amongst Canadian oncologists, and to determine if Canadian oncologists agreed with the relevant literature. Methods: A modified Delphi survey protocol was used to determine consensus of opinion amongst 83 Canadian experts identified by peers as leaders in LABC. Consensus was defined as > 85% agreement. Concurrently, a systematic review of the literature was performed to identify randomized controlled trials (RCTs) in this field (limits imposed were “humans”, “English language” and “RCT”). The protocols utilized in the RCTs were compared to the results of the consensus survey to determine if expert opinion in Canada is evidence-based or experiential. Results: Consensus of opinion amongst experts was obtained across all areas of patient management except for use of MRI in the workup of patients with LABC. 81% stated MRI would be required prior to initiation of therapy and 68% stated repeat MRI would be required prior to surgical planning in cases where lumpectomy is considered an option. Expert consensus reflected the published literature well in the areas of: clinical assessment with caliper at each cycle, option of lumpectomy if good clinical response, radiotherapy to loco-regional lymph nodes, and no further adjuvant chemotherapy outside of a clinical trial if residual disease is found at the time of surgery. On most other aspects of patient management the Canadian consensus was more conservative than the published literature, except for the use of salvage radiotherapy in the setting of progression on therapy, where the literature was more conservative than the Canadian opinion. Conclusions: A national practice consensus has been developed for the management of LABC which reflects the published literature or is more conservative than the published literature. The only area of clinical equipoise nationally is on the utility of MRI both pre and post neoadjuvant therapy. A further study assessing the appropriate role of MRI clinically in the treatment of LABC patients is warranted.
Bone-modifying agents for the prevention of bone loss in women with early or locally advanced breast cancer: a systematic review and network meta-analysis
