Would you treat a young patient with de novo triple negative breast cancer metastasis to the superior mediastinum as locally advanced with chemotherapy followed by radiation or palliative chemo immunotherapy if PD-L1 positive?

While this patient clearly meets criteria for M1 disease, if the superior mediastinum is her only site of disease beyond the breast and regional nodes I would give her 'the benefit of the doubt' and at least start her treatment with curative intent, since we can eradicate bulky disease in the breast...