Topics:
Breast Cancer • Radiation Oncology
Do you ever treat a recurrent breast cancer with RNI alone rather than chest wall and RNI?
A patient presents with clinically node-positive cT2 grade 3 invasive breast cancer in the upper outer quadrant. The patient had breast RT to 50 Gy with a 10 Gy boost for DCIS in the upper inner quadrant of the right breast 8 years prior.
The patient recently underwent neoadjuvant dose dense chemotherapy followed by mastectomy revealing a 2 cm tumor with no LVSI, negative margins, but with 3 out of 13 lymph nodes positive.
Would you favor treating with CW and RNI or RNI alone in this instance?
Answer from: Radiation Oncologist at Academic Institution
As this is a de novo case and not a recurrence, it would be reasonable to treat the nodes and leave the chest wall alone given the small size, absence of LVI, and adequate margins.
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Answer from: Radiation Oncologist at Community Practice
Retreatment indications are not absolute and are a function of absolute benefit vs. morbidity. For the above case, I would favor comprehensive RT unless RT effects from previous RT or breast suggest high morbidity with chest wall RT.