Can PMRT be avoided in patients with 1-3 + nodes if they achieve a pCR after neoadjuvant chemotherapy?

This is part of ongoing/completed B51 and practices have a wide variation.

In our practice, if it is t1 or t2 primary with non triple negative phenotype breast cancer and pCR, favor observation unless not happy with adequacy of SNLN (less than 3 or pre-chemo node not clipped) or the patient is < 40.

There is a cooperative group national randomized trial ongoing to answer that question. For a more in-depth response, please see JCO editorial by Marks and Prosnitz last year.