Would you consider APBI in a patient who meets all criteria but has high-risk genomic testing and is not receiving chemotherapy?

I would proceed with APBI 30 in 5 as it has a boost dose built in to account for a high genomic score.

In general, the commercial genomic tests (i.e., Oncotype DX and MammaPrint) were designed and widely tested as predictors of distant metastatic recurrence and thus escalation of adjuvant systemic therapies; however, several studies have subsequently demonstrated them also as predictors of LRR, which could guide recommendations here.

Mamounas et al., PMID 20065188 published a secondary analysis utilizing Oncotype from NSABP B-14 and B-20 in JCO in 2010, demonstrating that in patients treated with adjuvant tamoxifen (no chemo), the 10-year risk of LRR was 4.3% (RS 0-17, low risk), 7.2% (18-30, moderate risk), and 15.8% (RS >= 31). This is relevant here given that in the modern era, above low risk in general would be receiving adjuvant chemothe...