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Breast Cancer • Radiation Oncology
How would you treat cT3N1 ER/PR (-), Her2 (+) breast cancer who had mastectomy + ALND with a pCR in the nodes but ypT1 disease in the breast?
The patient has tissue expanders in place and is receiving ado-trastuzumab emtansine.
Would you treat with PMRT? If so, would you target the CW and RNI, or treat CW only? Would you favor a hypo-fractionated or conventional course?
Answer from: Radiation Oncologist at Academic Institution
Given increased pCR rates, this is something we are seeing more commonly. If possible, these cN1 patients are often undergoing SLN rather than ALND if SLN is negative.
I would offer PMRT for this patient given initial nodal involvement with T3 and ER- disease. Until we get data back from B51, my st...
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Answer from: Radiation Oncologist at Academic Institution
I generally treat any patient with clinical stage III who received neoadjuvant chemotherapy with PMRT to the chest wall and regional nodes, even patients with ypT0N0, regardless of biology, due to retrospective data showing better survival with PMRT (McGuire et al., PMID 17418973). I agree with Dr. ...
Answer from: Radiation Oncologist at Community Practice
If you have multiple + (at least one path proven) prexrt LN, I think it's typical to offer comprehensive (CW, SCV, AX) radiotherapy regardless of the post-chemo path end result. Some modification of the AX may be warranted if AXLND versus SLNB perhaps. It seems that AXLND are rare in the setting of ...