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How would you approach radiation for an elderly patient with pT2N1 TNBC s/p MRM and ALND who refused chemo-immunotherapy?
The patient is an elderly female with a good KPS who presented with a cT2N1 triple-negative breast cancer.
The patient refused chemotherapy and immunotherapy (both pre and post surgery) and is now status post mastectomy and ALND (1/12 LN positive, 2 cm, no ECE), found to have pT2N1 disease (4 cm tumor, +LVSI, Grade 3) with widely negative surgical margins?
Would you offer PMRT in this case? Why or why not?
Answer from: Radiation Oncologist at Academic Institution
Multiple randomized trials performed in the era before effective systemic therapy showed that PMRT did not reduce distant recurrence rates or improve overall survival (EBCTCG, PMID 37931633 and EBCTCG, PMID 10832826). Hence, the argument about whether to irradiate her falls into the category of "pro...
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Medical Oncologist at Apollo Hospitals
Does SUPREMO data change how one looks at PMRT?
Does SUPREMO data change how one looks at PMRT?
Radiation Oncologist at Beth Israel Deaconess Medical Center
Will address that soon in discussing this year&rsq...
Will address that soon in discussing this year&rsq...
Answer from: Medical Oncologist at Academic Institution
I would suggest that she reconsider trying adjuvant chemotherapy, specifically, the weekly paclitaxel and carboplatin regimen from the PATTERN trial, which was superior to an AC-T regimen as adjuvant therapy in TNBC. Assuming her oncologist suggested the KEYNOTE-522 neoadjuvant regimen or a similar ...
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Medical Oncologist at NYU Winthrop Hospital
Systemic therapy to reduce distant metastases and ...
Systemic therapy to reduce distant metastases and ...
Answer from: Radiation Oncologist at Academic Institution
The devil is in the details of the management of older patients with breast cancer. What are the patient’s short and long-term goals and priorities? How does she value the potential benefits afforded by PMRT relative to the inconvenience and modest risks associated with modern hypofractionated...
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Radiation Oncologist at Radiation Oncologists PC
I agree including the "elderly" reference. Now tha...
I agree including the "elderly" reference. Now tha...
I would absolutely consider PMRT. I would give 40/...
Agree and would treat
Given the numerous publications validating the ben...
Not so straightforward an argument as they make it...