Topics:
Breast Cancer • Radiation Oncology
In a very young woman who is s/p mastectomy for a small, high grade, Her2 positive breast cancer, with a micromet in a sentinel node, would you favor completion axillary dissection or PMRT or close surveillance?
Answer from: Radiation Oncologist at Community Practice
Micromets and mastectomy prospective and retrospective relatively large data available suggest regional recurrence rate is 0 to 5 percent without any additional regional treatment beyond SNLN in patients with t1 and t2 primary. I favor surveillance. The only time I consider treatment is triple-negat...
Answer from: Radiation Oncologist at Academic Institution
The short answer is I favor ALND for the additional staging information afforded by that procedure. I do not believe this patient’s risk of recurrence based on the available information (direct to surgery, small HER+ primary with micromet) is high enough to warrant the risks associated with co...
Answer from: Radiation Oncologist at Community Practice
To supplement the posts thus far, you may consider the following points in counseling the patient on probabilities of recurrence without RT:- In the observation arm of IBCSG 23-01, n=425 received BCS and 18.8% had IORT alone (in that way, generally had no radiation hitting part of the axilla). While...
Comments
Radiation Oncologist at Saint Thomas West Hospital
Ryan Jones presents a good condensation of literat...
Ryan Jones presents a good condensation of literat...
Answer from: Radiation Oncologist at Academic Institution
In HR+ and/or HER2+ disease, with good systemic therapy available, I do not feel strongly about PMRT for micromets, although will have a discussion about it. If the surgeon is considering ALND, then I think PMRT is a good alternative with less toxicity but neither is mandatory. I am more likely to r...
When you would treat, what are your volumes? Compr...
If I treat, I treat comprehensive CW and nodes