How would you manage a patient with a prior history of an ER+/PR+ breast cancer s/p mastectomy who develops nodal recurrence 2 years after surgery?

If a candidate for neoadjuvant chemo then chemo first, followed by ALND, and then comprehensive PMRT with nodal boost to all undissected nodes to 60 to 66 Gy based on response and residual nodal size.

If not a candidate for chemo then AI with CD4/6 inhibitor for downsizing and similar to above for l...