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Breast Cancer • Radiation Oncology
Is PMRT routinely recommended for all patients with positive lymph nodes after neoadjuvant chemotherapy?
Can it be avoided in patients with a microscopically positive lymph node?
Answer from: Radiation Oncologist at Academic Institution
This is a good question. In general at MD Anderson, we tend to recommend post-mastectomy radiation therapy for patients with residual micro- or macro-metastatic disease in the axillary nodes after neoadjuvant chemotherapy. This recommendation is strong when the patient had clinical stage III disease...
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Answer from: Radiation Oncologist at Community Practice
The prognosis and outcome for micrometastases after neoadjuvant chemotherapy is not the same as the same volume of disease before chemotherapy. The NSABP study showed that micrometastases in nodes after chemo is predictor for worse outcome in comparison to node negative disease and thus should be in...
Answer from: Radiation Oncologist at Academic Institution
I agree with @Benjamin D. Smith that the "biology" of the tumor should be a consideration in this setting, and this also applies in the context of ER+ disease. In addition to TNBC and HER2 amplified disease, patients with luminal B type tumors (ER+, HER2-, grade 3 and/or high Ki67, high oncotyp...