Criteria For Treatments

Question 1

Avoidance of radiotherapy - criteria

Answer 1

Age >=65
T1N0
ER +ve
Her2 -ve
G1 or G2
Agree to 5 years endocrine 

(NICE guidelines from PRIME II)

Question 2

Partial breast RT - criteria

Answer 2

Age >=50
<=3cm size
N0
ER+ve
Her2 -ve
Agree to 5 years endocrine

Question 3

Radiotherapy to SCF

Answer 3

1, >=4 axillary LN +ve

2, 1-3 axillary LN
AND
At 2 least high risk features: g3, lvi, age<=50, triple -ve, tumour size >=3cm

Also consider if >1 LN after NA chemo

Question 4

Chest wall Irradiation- post mastectomy

Answer 4

> =4 axillary LN
1-3 axillary LN and 1 high risk feature: G3, triple negative, extensive lvi

T3 (>=5cm)
Involvement of skin or 1mm radial excision margin

Question 5

Neoadjuvant chemotherapy

Answer 5

Locally advanced cancer- facilitate curative surgery
Her2 +ve
Triple negative breast cancer

Question 6

Reasons for mastectomy (BCS contraindicated)

Answer 6

1, multicemtric disease (>1 quadrant) or diffuse DCIS

2, incomplete wle after 2 attempts at bcs

3, extensive in situ component

4, recurrent breast ca after previous Irradiation

5, pregnancy - 1st or 2nd trimester (as want to avoid RT)

6, patient preference

7, active scleroderma or active SLE (relative contraindication)
(scleroderma associated with higher rates of skin fibrosis, retraction, ?lung fibrosis)

Relative- positive excision margin after re-excision

Question 7

Recommend axillary surgery

Answer 7

T3
Grade 3
Her2 +ve
Er -ve
Three positive sentinel nodes

No consensus on T2, LVI or extranodal spread - suggest continue to do clearance if SNB positive

Question 8

Staging not indicated after triple assessment if

Answer 8

T1/2/3