Node negative breast and SCV coverage

[firewicket]

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66yo female with a 3cm, left sided, IDC, Triple negative, 0/2 nodes, Grade 3, + LVSI, and ki67-95%. She is s/p lumpectomy and SLNBx, margins negative.

Would you cover the regional lymphatics?

 

[CharlestonRadOnc]

No - I wouldn't - the molecular profile of this tumor puts her at high-risk for DISTANT failure. Tangents alone, 50.4 to whole breast followed by boost to surgical cavity to 60.4 Gy.

 

[seper]

I would not treat nodes.

 

[firewicket]

What does everyone think about the recent MA-20 and EORTC in NEJM and ER negative breast cancer patients having an OS benefit with the inclusion of RNI? Note that this trial included node negative patients. I definitely wouldn't treat the IMNs unless they were involved on imaging, but there does appear to be a LRF benefit on 10 year follow up.

 

[seper]

was that an unplanned subgroup analysis?

 

[Palex80]

I would consider doing it, especially if the tumor was situated quite cranially.
Just as firewicket noticed, she's considered high-risk node negative per MA20 and would potentially benefit from such a treatment.

I'd actually give 16 Gy boost, for what it's worth. I regularly give 16 Gy to "high risk" patients and 10 Gy only to the ones with less risk factors.
Please note that we only have long term data on boost efficacy for the 16Gy-trial, the French 10Gy-trial was never published with updated data.

 

[Palex80]

was that an unplanned subgroup analysis?

The subgroup analysis of the MA20 & EORTC trials actually give you a hint that node negative patients may have been the ones that benefited the MOST out of RNI. However it's a subgroup analysis, not powered enough to make a point. Still it's intriguing.