What are the indications for PMRT in an ER/PR(+) Her-2(-) patient with a complete pathologic response in the nodes after neoadjuvant chemo, but with residual disease in the breast?

This is an area where there is still a paucity of information. Hence, all guidelines need to be very tentative.

I recommend PMRT for all patients having biopsy-proven axillary node involvement prior to chemotherapy, as I am concerned these are the patients at highest risk of local-regional failure. The results of the NSABP B51-RTOG 1304 trial will hopefully give much more data on this issue.

For other patients, my personal guidelines for recommending PMRT are:

• cT1-2cN0: ypN+
• cT1-2cN1: everyone ...

Subject to ongoing/completed NSABP B-51.

Off trial, will get different answers based on whom you talk to.

In our practice, would offer if pre-chemo was T3 or N2 disease or residual disease more than 2 cm in breast.