How would you approach radiation for an elderly patient with pT2N1 TNBC s/p MRM and ALND who refused chemo-immunotherapy?

RT will offer improved local control in this patient, as she has an elevated risk of LRR (positive LN, triple negative, large-ish T2, grade 3, LVSI).

It will be unlikely to change her survival, as the data for PMRT did not show survival benefit until the chemotherapy was good enough to decrease dis...

Multiple randomized trials performed in the era before effective systemic therapy showed that PMRT did not reduce distant recurrence rates or improve overall survival (EBCTCG, PMID 37931633 and EBCTCG, PMID 10832826). Hence, the argument about whether to irradiate her falls into the category of "pro...

The devil is in the details of the management of older patients with breast cancer. What are the patient’s short and long-term goals and priorities? How does she value the potential benefits afforded by PMRT relative to the inconvenience and modest risks associated with modern hypofractionated treat...

I would suggest that she reconsider trying adjuvant chemotherapy, specifically, the weekly paclitaxel and carboplatin regimen from the PATTERN trial, which was superior to an AC-T regimen as adjuvant therapy in TNBC. Assuming her oncologist suggested the KEYNOTE-522 neoadjuvant regimen or a similar ...