Topics:
Breast Cancer • Radiation Oncology
Would you offer hypofractionated PMRT to a pathologic T2N1a BRCA positive patient?
The patient is a young female with a pT2N1a ER/PR positive, Her-2 positive invasive ductal carcinoma of the upper inner quadrant of the right breast s/p bilateral mastectomy.
Post-operative pathology revealed a grade 3, 2.1 cm primary with associated DCIS, solid, comedo, and with positive LVI.
SLNx biopsy showed 1 of 5 lymph nodes involved (4 sentinel and 1 intramammary), with a 2.1 cm deposit, but no ECE. All margins were negative.
Would you consider hypofractionated PMRT acceptable in this instance?
Answer from: Radiation Oncologist at Academic Institution
I would irradiate this patient due to the combination of a positive node and LVI, regardless of her age. I define "young" as age 40 years or younger; others use age 35 to 45 as cut-offs. It's not clear what this patient's age is based upon the information given.All of the data to date from randomize...
Comments
Radiation Oncologist at Community Care Physicians
Would treatment effect in one lymph node qualify a...
Would treatment effect in one lymph node qualify a...
Radiation Oncologist at Varian Medical Systems/Allegheny health network
Yes, in the presence of other risk factors, and al...
Yes, in the presence of other risk factors, and al...
Answer from: Radiation Oncologist at Community Practice
BRCA has not been shown in any study to enhance RT effect or cause increased late morbidity with RT. I would offer PMRT with hypofractionation.
Answer from: Radiation Oncologist at Community Practice
I prefer conventional fractionation for PMRT with regional LN.
Comments
Radiation Oncologist at St. Vincent Hospital
Current NCCN guidelines indicate conventional frac...
Current NCCN guidelines indicate conventional frac...
Radiation Oncologist at Cleveland Clinic
In reconstructed cases, standard fractionation rem...
In reconstructed cases, standard fractionation rem...
In general, I agree and use the same rationale for...
Weng et al., PMID 33992718 Patel et al., PMID 301...