Would you consider PMRT in patients with clinically node negative breast cancer found to have micrometastatic nodal disease after neoadjuvant chemotherapy?  

Post neoadjuvant chemotherapy with residual disease in axilla reflects an incomplete response to chemo. The use of terms like micromets or ITC in this setting could be misleading, as these terms have been validated in patients who have upfront SNLN without any neoadjuvant chemotherapy. The NSABP Stu...

The decision to offer PMRT is based on the clinical stage and not the pathological stage after neoadjuvant chemo. MDACC had a retrospective review in patients with a complete PR after neoadjuvant chemo and found a 33% LR without PMRT vs 3% with PMRT. The fact that you have any residual disease after...

PMRT should definitely be a consideration, especially if 4 or more nodes contain micrometastatic disease. For 1-3 nodes, you could argue either way. I'd be more inclined to offer it for 1-3 nodes for a younger patient and/or if there are other poor prognostic factors such as grade, receptor status, ...