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Breast Cancer • Radiation Oncology
How do you approach breast RT in a patient with a recent history of ipsilateral thoracic irradiation?
A female in her 60's was simultaneously diagnosed with stage I triple-negative left breast cancer and stage I NSCLC of the left lung.
The patient had received 6400 cGy and carboplatin-paclitaxel-pembrolizumab for their NSCLC lung cancer 6 months prior, with a mean heart dose 1490 cGy, mean LAD 925 cGy & left lung V20 = 33%.
The breast tumor grew slightly despite the systemic therapy, and adjuvant Xeloda is planned. All margins were >5 mm.
Answer from: Radiation Oncologist at Community Practice
It depends on the specifics of the case, such as anatomy and dose to the ipsilateral breast, but patients like this may be a candidate for accelerated partial, hypofractionated partial, or RTOG 1014 approach with good heart/lung sparing. With accelerated techniques, it may be reasonable to wait unti...
Answer from: Radiation Oncologist at Community Practice
I do not see the dose that the L breast received or where the IDC of the breast is located in the L breast. Depending on the dose to the partial mastectomy site from the L lung radiation, she could receive TARGITed IORT if she declines a mastectomy. She fits the eligibility criteria for TARGIT-A: &g...
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Radiation Oncologist at Beth Israel Deaconess Medical Center
Intraoperative kilovoltage RT will certainly minim...
Intraoperative kilovoltage RT will certainly minim...
Answer from: Radiation Oncologist at Community Practice
I have a similar situation coming up with a TN right breast patient in her 70s with >10 axillary nodes and enlarged IMNs with an unresectable right hilar typical carcinoid found on staging. She's had a clinical and radiographic CR after the KEYNOTE-522 regimen and is going for BCT. She will need ...
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Radiation Oncologist at Beth Israel Deaconess Medical Center
Tough one, but I would include the right hilar mas...
Tough one, but I would include the right hilar mas...
Radiation Oncologist at Northside Hospital Duluth Hwy
Thanks very much!
Thanks very much!
Answer from: Radiation Oncologist at Community Practice
Thank you everyone. I felt that some form of whole breast treatment (vs. PBI) was preferable, given her poor response to chemotherapy. She was actually quite receptive to a discussion of mastectomy and probably would have chosen this if we had met before her surgery.
Answer from: Radiation Oncologist at Community Practice
Another option is proton therapy.
Thank you--this is exactly what I wound up telling...