Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2014-02-20
Reducing local therapy in patients responding to preoperative systemic therapy: are we outsmarting ourselves?
Related Questions
Would you offer RNI for young patient with cT3N0 triple negative breast cancer that had progression of disease during neoadjuvant chemotherapy, followed by mastectomy and sentinel node biopsy?
Yes, without hesitation. The primary randomized data suggesting an improvement in overall survival (OS) with PMRT in the T3N0 setting included RNI (e.g. Overgaard et al., PMID 9395428). There is also a study of +/- PMRT (including regional nodes) in T3 patients (about 40% of which were T3N0), that a...
Does a pathologic complete response in the breast and axilla change your radiation recommendations?
No. While it is tempting to assume that the chemotherapy has taken care of the local regional disease if there was a pathologic complete response (pCR), we do not yet have good assurance that this is the case. There is an ongoing randomized study testing this hypothesis in patients who have positive...
Would you offer PMRT to an ER/PR+, Her-2 negative cT3 tumor treated with neoadjuvant chemotherapy, but with a minimal treatment response?
The data on the risk of local-regional failure and the effect of PMRT on outcome are still too limited and contradictory to be certain of the correct answer. For example, the 10-year risk of LRF in the NSABP series of 95 cT3N0 patients having negative nodes but residual breast disease was 12% (1). H...
Can PMRT be avoided in patients with 1-3 + nodes if they achieve a pCR after neoadjuvant chemotherapy?
This is part of ongoing/completed B51 and practices have a wide variation. In our practice, if it is t1 or t2 primary with non triple negative phenotype breast cancer and pCR, favor observation unless not happy with adequacy of SNLN (less than 3 or pre-chemo node not clipped) or the patient is < 40.