When evaluating for PMRT in patients who did not receive neoadjuvant chemotherapy and are found to be pN0, do you utilize clinical T-staging, or pathologic T-staging?

For example, if preoperative imaging indicates T3 disease (non-mass enhancement extending over 5cm) but final pathology s/p mastectomy shows multiple foci of disease less than 5 cm (pT1-2), would you offer PMRT?

Are there any other factors that you would consider?

Answer from: Radiation Oncologist at Academic Institution

If no neoadjuvant therapy, I rely on the pathologic staging rather than clinical staging for PMRT decisions. So, for a cT3 that is a pT1-2, I would not offer PMRT. I do consider factors including receptor status, margins status, LVSI, and age.

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When evaluating for PMRT in patients who did not receive neoadjuvant chemotherapy and are found to be pN0, do you utilize clinical T-staging, or pathologic T-staging?

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