Would you offer hypofractionated PMRT to a pathologic T2N1a BRCA positive patient?

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...

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...

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.

I prefer conventional fractionation for PMRT with regional LN.