What is your preferred sequencing of adjuvant chemotherapy and PMRT for node + breast cancer?

Patient with pT2 N2a (6/9 LN+, 5 with macromets, 1 with focal ENE) ER/PR+, Her2- s/p mastectomy.

Is there compelling reason to start PMRT prior to adjuvant chemotherapy?

Answer from: Radiation Oncologist at Academic Institution

I addressed this issue for patients treated with breast-conserving surgery in May 2023; please see that answer for more details. To summarize, the toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when given after RT instead of before (Recht ...

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Radiation Oncologist at Northwestern University Feinberg School of Medicine
As always, I learn something new reading your answ...

Answer from: Radiation Oncologist at Community Practice

Chemotherapy followed by PMRT. In the modern era, no strong argument but may be for positive margin or driven by the patient's desire (social or personal commitments).

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What is your preferred sequencing of adjuvant chemotherapy and PMRT for node + breast cancer?

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