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Breast Cancer • Radiation Oncology
Would you offer PMRT to a young patient with a remote history of mantle/lung RT for Hodgkins lymphoma and a left cT0N1 triple positive breast cancer with a complete response after neoadjuvant chemotherapy?
The patient is less than 35 years old, and received 21 Gy to the mantle and 10.5 Gy to the lungs >15 years ago as part of treatment for Hodgkins lymphoma.
The patient now has a left-sided cT0N1 grade 3 ER-positive, PR-positive, HER2-positive invasive ductal carcinoma, with at least 2-3 bulky and other sub-centimeter axillary nodes that are FDG-avid on PET. She was staged as cT0, with a discordant <1cm UOQ lesion of the left breast that was FDG-avid on PET, but negative on biopsy.
She completed neoadjuvant chemotherapy followed by bilateral mastectomy and left sentinel node biopsy, ypT0 ypN0. She is now planned for adjuvant HP/endocrine.
Answer from: Radiation Oncologist at Academic Institution
I would favor adjuvant RT in this situation. Given up front bulky and multiple nodes, even though she had pathologic complete response. I would cover chest wall, axilla, and SCV fossa and consider IMNs based on cardiac and pulmonary doses.
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Answer from: Radiation Oncologist at Community Practice
Based on stage II disease and HER2 neu positive with PCR, I would favor no RT. More so in the setting of previous RT.
One thing I would ensure is that SNLN included targeted nodal biopsy also to reduce the risk of false negative results.
Comments
Radiation Oncologist at Community Health Network
I agree with this approach.
I agree with this approach.
Answer from: Radiation Oncologist at Academic Institution
Interesting and thought-provoking question. My initial instinct was to recommend comprehensive treatment (given the "bulky" nodes and her young age). But, on further reflection, given the ongoing study testing the use of PMRT in this setting (i.e. NRG/NSABP B51/RTOG 1304), I would likely be comforta...