When do you consider it too late after lumpectomy to offer adjuvant whole breast radiotherapy?
In a patient not receiving adjuvant chemotherapy who has a delayed consultation due to complications/personal issues, etc, is there a time delay at which there is no benefit to adjuvant RT?
Answer from: Radiation Oncologist at Community Practice
I don't know if there are studies which have looked at this - to say there is no benefit at a certain time frame. Retrospective studies have shown higher local recurrence with delay of RT with variable time period in those studies (8 weeks to 20 weeks) . The most recent one from British Columbia loo...
Answer from: Radiation Oncologist at Community Practice
The phrase, "The perfect is the enemy of the good" comes to mind...This is always a tough situation, but not uncommon in the "real world", especially with underserved patients. You hope that someone was proactive enough to place the patient on hormonal therapy if such a delay was anticipated.&...
Answer from: Radiation Oncologist at Academic Institution
This is a great question. I agree with @Sushil Beriwal, @Anthony E. Dragun and @Christopher D. Jahraus. Ideally, adjuvant RT within 8 weeks of surgery is optimal per a meta-analysis by Huang et al looking at timing of RT after surgery. In this meta-analysis, there were 10 studies looking at the inte...
Answer from: Radiation Oncologist at Community Practice
I agree with @Anthony E. Dragun's response, but I would also add that if the patient has been maintained on hormonal therapy (i.e. tam, AI, etc.), that really improves the argument for doing XRT, even if it's late. I would argue that you've potentially kept the patient in an oncologically quie...
Answer from: Radiation Oncologist at Community Practice
Hi everyone,
All the answers have been helpful. I have a question on the same line of thought.
If the time frame is a year since surgery and the person comes for adjuvant radiotherapy, would considering the patient's other risk factors make you inclined towards providing it (for example, ver...