Apbi

[deleted4401]

Don't know how to set up a poll, but curious about practice patterns. Would you treat these ASTRO "cautionary" patients with aPBI?

Case 1: 55 year old pre-menopausal woman, L sided IDC, Gr1, ER+, PR+, Her2Neu-, segmental mastectomy + SLNBx, unicentric, no LVSI, no DCIS, 1.0cm tumor, negative margins (closest 0.5cm). Oncotype low score. T1N0M0

- Would treat.

Case 1B: 48 year old pre-menopausal woman, L sided IDC, Gr1, ER+, PR+, Her2Neu-, segmental mastectomy + SLNBx, unicentric, no LVSI, no DCIS, 1.0cm tumor, negative margins (closest 0.5cm). Oncotype low score. T1N0M0

- Wouldn't treat, although eligible by ACS consensus statement.

Case 2: 65 year old post menopausal woman with R sided DCIS, Gr1 ER+, PR+, Her2Neu-, segmental mastectomy, unicentric, 1.0cm tumor, negative margins (closest is 0.7cm) no calcs seen on post-op mammogram. TisN0M0

- Would treat, and unsure why DCIS is still "cautionary" and not "suitable" based on institutional reports with combined 1000s of patients.

Case 3: 65 year old post-menopausal woman, L sided ILC, Gr1, ER+, PR+, Her2Neu-, segmental mastectomy + SLNBx, unicentric, no LVSI, no DCIS, 1.0cm tumor, negative margins (closest 0.5cm). Oncotype low score. T1N0M0

- Would treat, don't understand why ILC is such a concern.

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[deleted4401]

Sorry - all were N0.

 

[seper]

Agree with the above.

Except, what are the data for DCIS that you are referring to?

 

[seper]

I agree that limited DCIS is likely suitable for APBI. It's just the total numbers of patients reported is still in low 100's, not 1000's.

 

[Gfunk6]

Case 1: 55 year old pre-menopausal woman, L sided IDC, Gr1, ER+, PR+, Her2Neu-, segmental mastectomy + SLNBx, unicentric, no LVSI, no DCIS, 1.0cm tumor, negative margins (closest 0.5cm). Oncotype low score. T1N0M0

Yes

Case 1B: 48 year old pre-menopausal woman, L sided IDC, Gr1, ER+, PR+, Her2Neu-, segmental mastectomy + SLNBx, unicentric, no LVSI, no DCIS, 1.0cm tumor, negative margins (closest 0.5cm). Oncotype low score. T1N0M0

No

Case 2: 65 year old post menopausal woman with R sided DCIS, Gr1 ER+, PR+, Her2Neu-, segmental mastectomy, unicentric, 1.0cm tumor, negative margins (closest is 0.7cm) no calcs seen on post-op mammogram. TisN0M0

No. I'm afraid to treat DCIS with APBI. If we ever have trials as large as TARGiT, then I'll believe. However, I know I'm in the minority. My colleagues treat DCIS w/ APBI and I know a lot of local Rad Oncs do as well.

Case 3: 65 year old post-menopausal woman, L sided ILC, Gr1, ER+, PR+, Her2Neu-, segmental mastectomy + SLNBx, unicentric, no LVSI, no DCIS, 1.0cm tumor, negative margins (closest 0.5cm). Oncotype low score. T1N0M0

Yes

 

[Pewl]

Are we going by the ASTRO or ESTRO consensus report? The ESTRO age categories are all shifted 10 years younger, so by their standards 50y/o+ is "favorable" and 40-50 is cautionary. But, I suppose we do live in the US... (most of us)

Anyway, regarding DCIS I was under the impression that there simply wasn't enough prospective data. Furthermore DCIS kinda has a "skip" pattern, no?

I can't comment on ILC.

Anyone notice how loose the the B39 participation criteria are, compared to the ASTRO consensus favorable category?

 

[Palex80]

I would like to have the percentage of ER and PR positivity to take my final decision, but assuming they are quite high, here are my answers:

1. Yes
2. Yes, on trial only
3. No
4. No


ILC tends to present as multifocal disease, this is maybe why people don't like to treat with PBI. The theory behind it, is probably that you sterilize microscopic secondary tumor deposits with WBI. That's my guess at least...

 

[deleted4401]

Sorry - added an extra '0'. 100s is right.