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How would you treat an early-stage ER/PR+ Her-2 negative breast cancer s/p lumpectomy in an elderly patient who had sentinel node biopsy omission?

Given the CALGB 9343 trial, as well as the recent "Choosing Wisely" recommendation (https://www.choosingwisely.org/clinician-lists/sso-sentinel-node-biopsy-in-node-negative-women-70-and-over/) not to routinely use sentinel lymph node biopsy in this patient population, how should radiation oncologists approach this increasing clinical situation? ASTRO guidelines consider patients who did not have a lymph node evaluation as "unsuitable" for partial breast. Is WBRT indicated in this situation, or would this be over-treatment?
1 Answer
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Radiation Oncology · Allegheny Health Network, Pittsburgh
Answered on

I consider these patients as being managed appropriately surgically based on CALGB and current guidelines. As such, I routinely offer these patients APBI.

Unless there are other features, I do not think these patients need WBRT just because they didn't have a SLN. If they are eligible for omission of...

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