Would you offer PMRT to a patient with pTisN1a left breast DCIS?

Macrometastases suggest there is missed invasive disease in the midst of 11-cm DCIS. For one macromet with only SLNB done, I would add CW and RNI as part of treatment, but if I had an ALND, then RT can be avoided.

I would treat this patient for at least two reasons. And this is largely because I conceptualize the goal of these cases not as prevention of isolated locoregional recurrence, but as reduction of the risk of breast cancer (and overall) mortality.

In this case, the definition has invasive cancer, giv...

I discussed the indications I use for recommending PMRT for patients having upfront surgery at length in commenting on the implications of the SUPREMO trial in this forum on December 8, 2025. As I noted in that post, multiple studies have demonstrated low risks of axillary failure following mastecto...