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Would you treat the supraclavicular field and IMNs for a patient with cT3N0 breast cancer who has a complete response following neoadjuvant chemotherapy?

The subquestion can be "Ex if you are offering PMRT for reasons like young age and Her2+?
1 Answer
Mednet MemberInvited Expert
Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on

For T3N0 who have upfront mastectomy and the pathological nodal status is negative, if I offer PMRT, I usually treat chest wall only without treating the nodal region, as data suggests almost all locoregional recurrences are in the chest wall.
For clinical T3N0 who get neoadjuvant chemo and have residual disease in either their breast or axilla, I treat with PMRT and do treat regional node.
If a T3N0 has a pCR with neoadjuvant chemo then limited published data suggests a low risk of recurrence and I only treat selectivel patient like triple negative pathology. In these pt's I do treat RNI as the negative nodal status is post chemo and there is possibly more benefit of RNI in triple negative pathology.

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