Re-irradiation for invasive ipsilateral breast recurrence

[Kroll2013]

Dear colleagues,
I have a 54yo female patient that undergone a right breast conserving surgery in march 2015 for a T2N0 ductal carcinoma, triple negative. She received adjuvant chemotherapy as well as 30 fr of 3D conformal RT.
In July 2016 she presented with a growing mass of the right breast. She had total mastectomy with axillary dissection. Pathology showed undifferentiated ductal carcinoma with intracanalar Necrosis. No positive LN, neg margins, LVSI +

Is there an indication for CW re-irradiation??? Tx a lot


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[medgator]

Size of tumor? Still triple negative?

I'd say with negative nodes, no, imo you need a higher threshold to consider reirradiation than the standard criteria in a pt who presents with no xrt history, esp given the short interval from the first course of xrt

 

[evilbooyaa]

Wouldn't offer re-RT to CW unless I had to (and with that surgery, I don't see the draw). Obviously the majority of the radiated tissue has now been resected, but the CW is at significant risk still.

Agree with re-assessing receptor status to see if there's any benefit of tamoxifen.

 

[seper]

Tough case IMHO. At risk of loco-regional relapse due to + LVSI, especially if tumor was large.

 

[mavrik13]

Don't see the benefit, even with LVSI and the assumption this is a large tumour (don't know). Biologically thinking, this is either recurrent disease that has dedifferentiated and was radioresistant initially (and likely radiating now won't make a difference) or this is de novo disease where you would need a greater than typical benefit in reirradiating a chest wall due to increased risk of toxicity. I also strongly consider there is no randomized evidence of survival benefit in N0 PMRT.

 

[seper]

just wanted to point out, the Danish PMRT trials included T3N0

 

[medgator]

just wanted to point out, the Danish PMRT trials included T3N0

There is further data out there to show that those patients prob benefit the least though, may be most reasonable to treat them with chestwall only fields in some scenarios, or not treat if other factors are good (low grade ER+, old pt etc,, esp if pt had previous treatment)

 

[seper]

I'm aware of this. At the end of the day, level I evidence exists for survival benefit for T3N0.

There is further data out there to show that those patients prob benefit the least though, may be most reasonable to treat them with chestwall only fields in some scenarios, or not treat if other factors are good (low grade ER+, old pt etc,, esp if pt had previous treatment)