Would you offer PMRT to a young patient with a remote history of mantle/lung RT for Hodgkins lymphoma and a left cT0N1 triple positive breast cancer with a complete response after neoadjuvant chemotherapy?

I would favor adjuvant RT in this situation. Given up front bulky and multiple nodes, even though she had pathologic complete response. I would cover chest wall, axilla, and SCV fossa and consider IMNs based on cardiac and pulmonary doses.

Based on stage II disease and HER2 neu positive with PCR, I would favor no RT. More so in the setting of previous RT.

One thing I would ensure is that SNLN included targeted nodal biopsy also to reduce the risk of false negative results.

Interesting and thought-provoking question. My initial instinct was to recommend comprehensive treatment (given the "bulky" nodes and her young age). But, on further reflection, given the ongoing study testing the use of PMRT in this setting (i.e. NRG/NSABP B51/RTOG 1304), I would likely be comforta...