Topics:
Breast Cancer • Radiation Oncology
Would you offer re-irradiation for a patient with a left sided medial DIEP flap recurrence with a history of prior whole breast radiation 25 years ago?
The patient is in her 70s and had a prior breast recurrence 10 years ago treated with mastectomy and reconstruction; this most recent recurrence has the favorable features of her prior recurrence (2cm in size, ductal w lobular features, grade 2, no LVSI, no epidermal involvement, strongly ER/PR positive with a ki67 of 1% and resected with widely negative margins).
Would you offer re-irradiation, and if so, what fractionation scheme and why?
Answer from: Radiation Oncologist at Academic Institution
I would favor reirradiation if otherwise healthy, though favorable features, she has had 2 recurrences (albeit 15 and now 10 years later).
If hyperthermia is available, I would consider 32-40 Gy/twice weekly with hyperthermia.
If not hyperthermia, I would offer 40 Gy/15 fractions and boost t...
Answer from: Radiation Oncologist at Community Practice
What about a 2-year interval (originally T1cN0 Oncotype 39 refused chemo, had short course plus 1k boost)?
Choices might include:
Mod hypofrac partial breast as suggested above
SBRT (30/5 2x week) given the good cosmetic outcomes in de novo patients
Or... what would make you willing ...
Comments
Radiation Oncologist at Cleveland Clinic
If previous breast conservation with 40/15 + 10/5 ...
If previous breast conservation with 40/15 + 10/5 ...
Radiation Oncologist at Jacob E Locke MD PA
Thank you for the 1014 regimen suggestion.
Thank you for the 1014 regimen suggestion.
What if her most recent recurrence was triple nega...
Then I would treat usually with 1.8 to 2 Gy per fr...