Would you recommend PMRT in a patient with a triple negative cT2N0, ypT2N0 metaplastic breast cancer s/p NAC, mastectomy, and SLNB?

I would favor it, as these metaplastic tumors are aggressive triple-negative diseases with mixed responses to chemo. In this case, lack of any response and residual of more than 2 cm for this histology, I would favor RT.

I assume this patient did not have a positive axillary node biopsy prior to starting neoadjuvant chemotherapy (NACT). If she did, then I would irradiate her until we have more information from the NSABP B-51 trial as I discussed in December 2023.

There is a paucity of data on the local-regional failu...