New Breast LN XRT Guidelines

[RadOncMegatron]

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I just saw this and wanted everyone’s thoughts on using Oncotype DX RS to determine radiation risk / benefit. Looks like the authors have it on the algorithm for determining RNI, but my understanding was that it’s too early to use for local control.

https://www.practicalradonc.org/article/S1879-8500(26)00001-9/abstract?fbclid=IwZXh0bgNhZW0CMTEAc3J0YwZhcHBfaWQPNDA5OTYyNjIzMDg1NjA5AAEeBZezW-u2lJE1iYyvLzYi4A3WpxtsEOpW4uD_Cg96PwPOZzVR6L1UWsDiWtk_aem_SEvPBXhV6F-tC-m7o7z43w

 

[madchemist89]

I wasn’t able to find the article at the link.

 

[RadOncMegatron]

I wasn’t able to find the article at the link.

I fixed the link. Title is “Lymph Node Management of Patients With Breast Cancer in the Era of Therapy De-escalation” in PRO.

 

[fiji128]

Nice review article.

 

[TheWallnerus]

In chess we sometimes say "It's a move."

It's an article. A fair number of "±"'s.

Good to see that not everyone is applying ENI as a class solution for N+ anymore. I would never say I told you so 🙂

However, just wanna check one other thing. Re: the "level 1/2" axillary RT... this is based MORE on assumption/extrapolation and not evidence/proof really, right. I don't mean it to sound accusatory, but I can't really frame the question briefly in another way.

And I agree I would use criteria from randomized trials specifically testing ENI questions for ENI; Oncotype I would not use for ENI decisions.

 

[evilbooyaa]

Wouldn't put any stock into figure B of the paper shown. De-escalating RT in cN+ is silly if you're still doing a ALND.
Worry about de-escalating the ALND down to a SLNB + Targeted nodal dissection and patients will do much better, even if they need radiation on the backend.


For Figure A, until the randomized trial comes out, I wouldn't use Oncotype as a decision tool. People putting the cart before the horse in other oncological scenarios where there is literally an ongoing trial asking the question..... have hurt patients in the past. It's breast cancer. Follow the randomized data to the best of your ability, there's no need extrapolate.