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
Breast case
31 y/o T2NO er/pr positive, vus in brca 2, no significant cancer history in family. Already got lumpectomy x 2 (initial + margins). Mastectomy never discussed as option. Have polled some surg onc colleagues at top tier places and probably 60/40 in favor of offering mastectomy. Thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - July 27, 2022 Category: Universities & Medical Training Authors: Reaganite 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 case - fractionation
79 year old with a 4.1 cm ER/PR +, Ki 67%, Her 2 (-) IDC with neuroendocrine features.
Final path after lumpectomy pT2N0. 1/2 SLN"s had ITC's. One margin close at < 1mm but no tumor on ink.
I met with her pre op and we were thinking 26 Gy in 5 WBRT.
With that big of a tumor and close margin, would you boost on top of that or switch to 40 in 15 with boost?
Or just leave it at 26 Gy in 5.
She's in pretty good shape. Oncotype pending. (Source: Student Doctor Network)
Source: Student Doctor Network - February 13, 2021 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums
Experience with metaplastic breast carcinoma?
Hello,
I recently saw a 70y/o lady with a left breast pT2N0 grade 2 metaplastic carcinoma with a tiny invasive lobular component. She had a lumpectomy with widely clear margins and negative sentinel nodes.
Most of the literature I've seen on this essentially treats it as routine breast. Although, I think metaplastic carcinoma counts as a spindle cell neoplasm. Would any of you use a hypofx regimen such as Whelan Canadian or just do standard long course?
Anyone recall any similar cases...
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Source: Student Doctor Network - January 19, 2021 Category: Universities & Medical Training Authors: Pewl 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
Re: Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial
(Source: BMJ Comments)
Source: BMJ Comments - November 19, 2020 Category: General Medicine Source Type: forums
Complex elderly breast case.
I have an 83 year old that had a 5 cm VERY far medial left breast mass, eroding into skin and rib/pec muscle. She has a number of comorbidities including CHF with a pacer/defib.
Clinical staging was T3N1 (a few axilla nodes)M0.
She had an excision of the mass (just did a "lumpectomy") and axillary dissection. + margins into the chest wall muscle as you'd expect. Really surgeon didn't think she'd do as well with a mastectomy and family reports surgery was "really hard on her" so no more...
Complex elderly breast case. (Source: Student Doctor Network)
Source: Student Doctor Network - November 10, 2020 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums
TARGIT-A trial authors & #039; reply 5: Risk-adapted single-dose TARGIT-IORT during lumpectomy for breast cancer - as effective as whole breast radiotherapy with lower non-breast cancer mortality.
(Source: BMJ Comments)
Source: BMJ Comments - November 9, 2020 Category: General Medicine Source Type: forums
TARGIT-A trial authors & #039; reply 6: Risk-adapted single-dose TARGIT-IORT during lumpectomy for breast cancer - as effective as whole breast radiotherapy with lower non-breast cancer mortality.
(Source: BMJ Comments)
Source: BMJ Comments - November 9, 2020 Category: General Medicine Source Type: forums
Re: Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial
(Source: BMJ Comments)
Source: BMJ Comments - October 26, 2020 Category: General Medicine Source Type: forums
PBI in N1mi (actual radiation question)
We should have a sub-forum where we ask radiation questions... Have a lady with a RUOQ T1N1mi ER/PR+ breast cancer s/p lumpectomy and SLNB with microscopic disease in the SLN. She has lupus with some mild cutaneous manifestations on plaquenil. She doesn't want mastectomy, and have discussed risks. The cavity with margin and level 1/2 could be treated pretty conveniently instead of WBRT, sparing a ton of tissue. Was wondering if this sounds reasonable in this setting. (Source: Student Doctor Network)
Source: Student Doctor Network - September 5, 2020 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums
Re: Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial
(Source: BMJ Comments)
Source: BMJ Comments - September 5, 2020 Category: General Medicine Source Type: forums
TARGIT-A trial authors ’ reply 2: Risk-adapted TARGIT-IORT during lumpectomy for breast cancer - as effective as whole breast radiotherapy with lower non-breast cancer mortality.
(Source: BMJ Comments)
Source: BMJ Comments - September 4, 2020 Category: General Medicine Source Type: forums
TARGIT-A trial authors ’ reply 3: Risk-adapted TARGIT-IORT during lumpectomy for breast cancer - as effective as whole breast radiotherapy with lower non-breast cancer mortality.
(Source: BMJ Comments)
Source: BMJ Comments - September 4, 2020 Category: General Medicine Source Type: forums
