Topics:
Breast Cancer • Radiation Oncology
What volumes would you cover for cT3N0, ypT2N0 breast cancer s/p neoadjuvant chemotherapy and lumpectomy/SLNB?
If the patient were of young age with high grade and ER+ disease without LVI, do these factors sway you one way or another?
Answer from: Radiation Oncologist at Academic Institution
There is still little information about the patterns of failure in patients treated with neoadjuvant systemic therapy. The NSABP study of this issue found the 10-year rate of nodal failure for patients with cT3N0 lesions who had residual breast disease but negative nodes at surgery was 3.2% for the ...
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Answer from: Radiation Oncologist at Community Practice
I would follow the same principle as I would for PMRT for her and favor comprehensive RNI.
Nagar et al., PMID 21885207
This is the principle I follow forT3 N0 with partial response. Also in the modern era, chemotherapy would be offered in the neoadjuvant setting for node negative disease with high...
Answer from: Radiation Oncologist at Academic Institution
The main indication for adjuvant RT, in this case, is the fact the patient had a lumpectomy, so I would only offer whole breast RT. I think it's reasonable to add RNI if there is extensive LVI and/or if the biology is high risk as Dr. @Shah mentioned.There is really no strong prospective data s...
Answer from: Radiation Oncologist at Academic Institution
I think you can go either way with this. I would tend to favor RNI for those at higher risk (ex. ER negative), while considering breast only for older patients with ER+ disease.
That being said, I agree with Dr. @Beriwal in that you could use PMRT consideration and treat RNI for all.
Answer from: Radiation Oncologist at Community Practice
I would treat the breast only here. Agree with RNI only if high risk features. Using the PMRT consideration (assume no neoadjuvant chemotherapy), the data from NSABP on T3N0 showed that risk of loco-regional failure without PMRT was only 7%. Therefore, a great majority of T3N0 ER+ do not need PMRT p...