For a young patient with advanced TNBC with a single lung nodule status post NAC, not amenable to biopsy, would you consider SBRT to the lesion?

Look for prior imaging (they’re young so may not have prior chest imaging with any significant lead time to draw any conclusions). In the absence of any evidence of other sites of disease and no history of evolution of that nodule, I’d move forward with the completion of appropriate adjuvant therapy for the chest wall and observe with repeat CT C/A/P in q3months until you establish evolution or stability. If it grows, re-discuss biopsy with IP and IR. If truly not amenable to biopsy, I’d consider involving thoracic surgery for a diagnostic/therapeutic wedge as it may significantly change the calculus of this patient’s management. If all of those options aren’t possible and the suspicion of malignancy is high, I’d have a nuanced discussion o...

I would probably continue adjuvant chest wall/nodal radiation and would treat the lung nodule with SBRT. The patient is likely in trouble if she progressed during NAC, but local recurrences can be very morbid and the radiation is not associated with really bad toxicity. Regarding the lung metastasis, here is what gives me pause:

1. Oligoprogressive breast cancer may not benefit from MDT. The CURB study recently published in the Lancet and presented at ASTRO 2021 showed no improvement in progression-free survival with SBRT in oligoprogressive breast cancer patients (Tsai et al., PMID 38104577). The NRG-BR002 study presented at ASCO 2022 also showed no improvement in progression-free survival with SBRT in oligometastatic breast cancer patients (...