What is your approach to women with breast cancer who opts for a staged approach with up-front lumpectomy and SLN biopsy (pN-) when there are indications for adjuvant radiation therapy but she plans for a later mastectomy (=>6 months)?
Patient will not have any chemotherapy in the interim. Would this change if the patient was pN+ and still not receiving chemotherapy? We are seeing this approach increasingly for women who want to preserve the nipple and areola so they have a lumpectomy and lift, and then significantly delayed mastectomy. Also seeing this in patients to get them to surgery faster because of delays due to coordination of plastic surgery and breast surgery schedules.
2 Answers
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Radiation Oncology · Allegheny Health Network, Pittsburgh
Answered on
That is not a common approach I have seen, and I would question the rationale of putting a patient through two surgeries when one can be done and forgo RT. If pN0, it would depend on what significant delay is, and I would extensively counsel the patient on recurrence risk should they end up forgoing...
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Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on
I would not offer RT if planned for mastectomy in 6 months, as based on phenotype, median time for recurrence is 2 to 5 years, and RT can also negatively impact the cosmetic outcome with reconstruction.
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