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In a patient with favorable risk pT1N0(mic/i+) breast cancer and favorable anatomy, would you use IMPORT-LOW style PBI while incorporating the high axilla?

The patient is pT1c ER+/PR+/HER2- grade 1 IDC, LVSI-, N0(i+) with an upper outer cavity and a ~29cm breast separation If the cavity location is such that an IMPORT-LOW style mini-tangent could actually incorporate the partial breast target and high axilla by raising the upper field edge. Would you feel comfortable taking this approach, or would you convert to whole breast RT with high tangents?
2 Answers
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Radiation Oncology · Allegheny Health Network, Pittsburgh
Answered on

For N0(i+), PBI is appropriate, I would not include axilla. 40/15, 30/5.

If N1mic, would not use PBI but would favor WBI, high tangents if ER+, RNI if ER-.

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Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on

I would treat like node negative and IMPORT LOW without axilla or APBI like levy; both reasonable options.

I would prefer APBI as less exposure and thus less side effects in large breast size compared to IMPORT LOW.

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