Would you consider APBI in a patient who received neoadjuvant chemotherapy?

The selection criteria we use for APBI are based largely on pathologic characteristics determined following upfront surgery. The findings in patients undergoing neoadjuvant chemotherapy cannot simply be assumed to have the same implications as those in patients having surgery first, and their meaning might be quite different. I am not aware of any studies of giving APBI following neoadjuvant chemotherapy yet. Therefore, I would not give APBI outside a formalized clinical trial.

I do not consider APBI in patients who have received neoadjuvant chemotherapy. While I am aware that some do, I do have concern regarding encompassing volume at risk.

With more patients receiving neoadjuvant endocrine therapy, this is also an area where we don't have great data. I have not traditionally offered these patients APBI for the reason above.

Interesting question. However, I am not offering APBI after neoadjuvant chemotherapy. This situation would pose multiple difficulties, as the criteria for APBI eligibility are currently based upon pathologic factors in the absence of neoadjuvant chemotherapy. In addition, many of the patients receiving neoadjuvant chemotherapy would be deemed cautionary or unsuitable under current ASTRO criteria (for example, younger patients, those with known positive lymph nodes, those with tumors over 3 cm, t...

There is no data in this setting, and not knowing what the real target is could lead to higher recurrence, unless done in a clinical trial setting.