In a locoregionally advanced breast cancer with multiple positive surgical margins, how safe is it to wait for a re-excision vs treating upfront with comprehensive RT if surgery cannot be done the short term due to the COVID outbreak?

Topics: Breast Cancer • Radiation Oncology • COVID-19

Radiation in the setting of positive margins is sub-optimal and from my understanding high boost doses do not replace further surgery. Is it better to wait some time until re-excision done or to treat comprehensively and leave surgery for salvage with the understanding of providing sub-optimal control outcomes?

Answer from: Radiation Oncologist at Academic Institution

Agreed, higher radiation dose will not replace negative margins. Obtaining negative margins is ideal. If the patient is a systemic therapy candidate, I would agree with @Sushil Beriwal and proceed with systemic therapy and then re-excision.

Comments

Radiation Oncologist at Radiotherapy Cancer Center (RTCC)
Thank you.

Answer from: Radiation Oncologist at Community Practice

At our institution, we let the patient continue systemic treatment (AI or chemo based on phenotype) with plan for re-excision once COVID-19 settles down and then RT.

Comments

Radiation Oncologist at Radiotherapy Cancer Center (RTCC)
Thank you.

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