Breast RNI and IMN coverage Discussion.... Again. Breast is the worst x 4?
New breast is the worst case. Just saw a 39 yo with a BRCA mutation who had what was called a cT2N2 ER+ PR-/HER2- breast cancer. This was in the setting of a biopsied 4.6 cm primary and an MRI with 7 abnormal-appearing axillary nodes, none of which were biopsied. Got neoadjuvant chemo followed by lumpectomy and ax dissection. Final staging was ypT1aN0. Residual primary was 1.5 mm with treatment effect noted. 0/17 nodes with no treatment effect noted. For reference, an abnormal node...
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Source: Student Doctor Network - April 3, 2024 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums
Re: Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): randomised, double blind, multicentre, phase 3 trial
(Source: BMJ Comments)
Source: BMJ Comments - November 12, 2023 Category: General Medicine Source Type: forums
Breast is the worstest of the worstest: Late recurrence and re-irradiation.
Invasive lobular breast cancer on the left side pT1c pN0 (sn), received BCS und adjuvant RT to the breast (50 Gy to the breast + 10 Gy boost) in 2002, she was in der 40s back then. ER+ PR+ Her2-
She remained in remission for 20 years, underwent adjuvant endocrine therapy for 5 years.
Now, in her 60s, she presents with a large recurrent tumor (8cm) in the left breast and one possible axillary node. PET-CT negative for futher disease. Biopsy shows the exact same biology as 20 years ago...
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Source: Student Doctor Network - November 30, 2022 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums
is PMRT needed for this patient?
54 years old patient, PS0, no medical comorbidities (obese), no family history of breast cancer
underwent a MRM + LND for left Breast invasive Carcinoma
Pathology showed:
- T4cm, 0Ln/18 dissected pT2N0, free margins
- G3, LVI ++,
- ER 50%, PR 10%, Her2 neg
- Ki 30% (Source: Student Doctor Network)
Source: Student Doctor Network - May 10, 2022 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums
Breast is the worst: another, another case!
Another case for the thread given title. 42 yo with cT1cN0 ERPR- HER2+ at 2:00 in the right breast who got NA TCHP. Lumpectomy with ypT1bN0 but with ITCs in 1 of 3 nodes. I'm wondering about RNI given medial location, lack of CR and ITCs in one of the nodes. Also, wondering about completion ax dissection vs going forward with RT. I'm up for being convinced to do as little as possible. (Source: Student Doctor Network)
Source: Student Doctor Network - December 16, 2021 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums
Breast is the worst: another case!
42 year old healthy female diagnosed with a huge DCIS , received mastectomy and sentinel lymph node dissection.
Inside the 11cm big DCIS, 2 invasive ductal carcinomas were found, biggest one was 2.2cm in diameter.
Axillary status is pN1 with a micrometastasis in 1 / 3 nodes (0.5 mm), no ECE.
Reconstruction was performed with an implant. Oncotype Dx score is 12, so no chemotherapy.
So, it's a pT2(m) pN1 (1/3mi) cM0 L0 V0 Pn0 R0 ER100% PR10% Her2- G2 invasive ductal carcinoma.
Looking...
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Source: Student Doctor Network - June 30, 2021 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums
cT1N0 breast cancer. RNI?
65 yo cT1N0 ER/PR- HER2+ with NA taxol/herceptin. s/p lumpectomy and SLNB, ypT1N1 with 4 mm focus of residual disease in the node. Had she been cT1N1 and ypT1N1 I'd do RNI. Had she been cT1N0 and pT1N1, I'd probably just do WBRT. Wondering if there's a way to not do RNI here. (Source: Student Doctor Network)
Source: Student Doctor Network - December 28, 2020 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums
Her2/Neu brain mets
I am trying to identify literature which reports the incidence of leptomeningeal dissemination (LM) in patients with resected HER2/neu amplified brain mets in the posterior fossa. Can anyone help point me in the right direction? (Source: Student Doctor Network)
Source: Student Doctor Network - March 2, 2020 Category: Universities & Medical Training Authors: Gfunk6 Tags: Radiation Oncology Source Type: forums
metastatic breast Ca that responded very well to CT.....
Dear Colleagues,
What would you do in this case?
57 years old female with no comorbidities, that presented with a metastatic breast carcinoma.
Locally, the tumor was very locally advanced ulcerating into the skin and invading the pectorals with high burden of disease in the axilla.
Pet CT showed: positive nodes in the mediastinum, hilarious regions and many lung nodules.
she is ER/PR+, Her2 negative, IDC.
she received upfront chemotherapy with significant response:
- significant...
metastatic breast Ca that responded very well to CT..... (Source: Student Doctor Network)
Source: Student Doctor Network - September 3, 2019 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums
PMRT for this patient?
Dear colleagues,
i need your opinion concerning this patient:
44 yo patient diagnosed of a bifocal mass of the right breast 5*2*3 cm , UOQ, cN0 , no suspiscious nodes on MRI
biopsy showed a poorly differentiated IDC with extensive high grade DCIS, HR neg, Her2 positive
she received neoadjuvant chemotherapy with complete response.
pathology of the radical right mastectomy with sentinel node showed:
no residual tumor, 0/1 LN, LVSI was not specified.
do you give PMRT taking into...
PMRT for this patient? (Source: Student Doctor Network)
Source: Student Doctor Network - May 30, 2019 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums
