Would you offer PMRT to an ER/PR+, Her-2 negative cT3 tumor treated with neoadjuvant chemotherapy, but with a minimal treatment response?

The data on the risk of local-regional failure and the effect of PMRT on outcome are still too limited and contradictory to be certain of the correct answer. For example, the 10-year risk of LRF in the NSABP series of 95 cT3N0 patients having negative nodes but residual breast disease was 12% (1). H...

I would not hesitate to treat. PMRT has been demonstrated in prospective clinical trials to improve overall survival in patients with pathologic T1-3N0-1 disease (w/o upfront chemo) (e.g. Ragaz and Overgaard). This positive result was seen in essentially all subgroups considered (though not in T3N0 ...

I don’t see a compelling reason for PMRT in this case. Given ER-positivity, it is not surprising that the chemo response was modest. Without any other adverse factors or nodal involvement, I would not recommend. However, if prior to chemo she had a documented positive node, I would treat until we kn...

For cases such as these where we don’t have clear prospective data, with mostly favorable pathology and a somewhat expected poorer response to neoadjuvant chemotherapy given receptor status, in my opinion, it comes down to the age, performance status, and level of comfort with a potential increase i...