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?

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Radiation Oncology · Beth Israel Deaconess Medical Center

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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...

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Radiation Oncology · Allegheny Health Network, Pittsburgh

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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 hypofractionat...

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Radiation Oncology · Varian Medical Systems/Allegheny health network

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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.

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Radiation Oncology · New York Cancer and Blood Specialists

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I prefer conventional fractionation for PMRT with regional LN.

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