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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 Community Practice
I would consider PMRT for this patient given nodal involvement, LVI, and young age with single node involved without ALND.
I typically use standard fractionation postmastectomy if reconstruction is present until we have mature outcomes from RT-CHARM.
If non-reconstructed, I'd consider hypofraction...
Comments
Radiation Oncologist at Weill Cornell Medical College
In general, I agree and use the same rationale for...
In general, I agree and use the same rationale for...
Radiation Oncologist at Varian Medical Systems/Allegheny health network
Weng et al., PMID 33992718 Patel et al., PMID 301...
Weng et al., PMID 33992718 Patel et al., PMID 301...
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 Allegheny Health Network, Pittsburgh
In reconstructed cases, standard fractionation rem...
In reconstructed cases, standard fractionation rem...
Would treatment effect in one lymph node qualify a...
Yes, in the presence of other risk factors, and al...