Topics:
Breast Cancer • Radiation Oncology
Would you include the regional nodes when treating with PMRT in a patient with a high grade, large primary tumor, but low burden axillary disease with a complete axillary dissection (e.g. 1/20 nodes involved)?
Answer from: Radiation Oncologist at Academic Institution
This is a question we are seeing more and more. I break these cases down into two situations:
1. Postmastectomy, no neoadjuvant: In these cases, I extrapolate from MA20 which looked at patients undergoing breast conservation with ALND and a large percentage had low nodal burdens. RNI was associated...
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Answer from: Radiation Oncologist at Academic Institution
I'm assuming this patient went directly to surgery and has received adjuvant chemotherapy. Most patients on the NCIC MA.20 trial had small tumors (~ 52%< 2 cm, ~99% < 5 cm) that were ER+ with relatively low nodal burden. A large majority would have also had grade 1-2 disease (i.e. "favorable b...
Answer from: Radiation Oncologist at Academic Institution
If the patient was ER+ and had a low Oncotype score, I would consider enrollment in MA.39, which would randomize this patient to PMRT with comprehensive nodal RT versus no PMRT.
Otherwise I agree with the response by @Chirag S. Shah, and would treat the undissected axilla and the supraclaviular fos...