Would you offer whole-breast RT to a BRCA-positive patient who has multifocal recurrent disease after APBI?
The patient is BRCA2 positive and previously received 30 Gy in 5 fraction APBI to the right breast for an ER/PR+ pT2N0 IDC. She then developed multifocal recurrent disease while on adjuvant tamoxifen (grade 3, ER/PR+, 8 mm and 2.5 mm, 0/2 SLN) 18 months after her prior RT.
Would you offer re-treatment to the right breast in this instance if the patient declines mastectomy? If so, what dose and fractionation would you consider, and why?
1 Answer
Mednet MemberInvited Expert
Radiation Oncology · Allegheny Health Network, Pittsburgh
Answered on
Before considering re-irradiation, I would counsel this patient extensively that they should have a mastectomy in this situation given the BRCA2 positivity, and recurrence vs. new primary < 2 years after treatment with RT.
If the patient absolutely refuses mastectomy, re-irradiation could be consider...
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