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Topics:
Breast Cancer • Radiation Oncology
Would you cover regional nodes in an early-stage breast cancer with a non-mapping sentinel lymph node?
The patient is an otherwise healthy female in her 70s with an ER-positive, PR-negative, HER2-negative grade 3 invasive ductal carcinoma.
Lumpectomy revealed a 15 mm tumor of the upper inner quadrant with negative margins. She is willing to take endocrine therapy.
The patient had a high-risk Oncotype Dx score but refused chemotherapy. She is willing to take endocrine therapy.
Answer from: Radiation Oncologist at Academic Institution
Based on the SSO Choosing Wisely Guidelines (https://www.surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf) to not routinely use SLN biopsy in clinically node negative women ≥70 years of age with early stage hormone receptor positive, HER2 negative invasive breast c...
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Answer from: Radiation Oncologist at Community Practice
I would include levels 1 and 2 in the RT field if the patient opts for whole breast RT.
Answer from: Radiation Oncologist at Community Practice
I'd cover the SCV.
Answer from: Radiation Oncologist at Community Practice
Known risk factors:
Grade 3 disease
Medial tumor location
High Oncotype score, declining recommended chemotherapy
Despite age > 70, given good health/life expectancy, other risk factors including LVSI or luminal B disease would lead me to cover regional nodes including the IM chain and SCV fo...
Answer from: Radiation Oncologist at Community Practice
So we have a woman in her 70s with ER+ PR- HER2- stage 1a breast cancer who refuses chemotherapy and is considering RNI in addition to WBRT and endocrine therapy.
I don't believe one can show a survival advantage to RNI in this situation, although there was a meta-analysis done after PRIME II looki...