Locally advanced breast cancer: NAC Flashcards
Which key factors influence RT following Neoadjuvant Chemotherapy (NAC) ?
Pre-Treatment: Age, menopausal status, Nodal status, T-stage, Tumor subtype/biology
Treatment: surgical treatment of the breast, breast reconstruction, adjuvant systemic therapy
Post-treatment: Tumor response to NAC, nodal status, T-stage, surgical margin status
What are the pre-neoadjuvant chemotherapy factors contributing to locoregional recurrence?
Age < 50
Premenopausal
Tumor subtype (Triple negative disease)
T4 disease
cN2/3
Stage III disease
T3N1: a lot of data suggest that response to NAC is a more important indicator of local recurrence than the actual clinical stage
What are the post neoadjuvant chemotherapy factors contributing to local recurrence?
Tumor extent (response to chemotherapy)
pCR is particularly prognostic in pts with triple negative and HER2+ disease.
Adjuvant systemic therapy
Which patients need PMRT and RNI after NAC?
cN1 patients ————-> ypN1
Almost always need RNI
Data supporting this come from two trials NSABP B-18 and B27. In a multivariate analysis, it was shown that if a patient a node positive residual nodal disease, she was almost three times likely to recur as compared to someone who did not have residual disease.
cN1 patients ————-> ypN1, omission of RNI possible?
While RNI for ypN1 patients if the SOC, data from studies with small numbers of patients with limited follow-up suggest that biological subtype and treatment with modern targeted agents (HT or Trastuzumab) impacts local regional recurrence risk and could possibly obviate need for RNI.
cN1 patients ————-> ypN0
Sometimes need PMRT and RNI
Although patient numbers are small, NAC-studies indicate that the rate of local recurrence in cN1 patients who become ypN0 is generally low and while post-lumpectomy radiation is still needed, PMRT may not be necessary
Most recurrences among ypN0 patients appear to be in the chest wall or breast and suggest RNI may not be necessary
Nevertheless, ypN0 patients with triple negative disease and additional high-risk features like residual breast disease, young age and LVSI may still benefit from RNI.
Wie ist die Radiotherapie nach NACT (Neoadjuvante Chemotherapie) bei lokal fortgeschrittenen Mammakarzinom zu sehen?
Prätherapeutisch cT3-4 oder cN2-3
Posttherapeutisch pCR/keine pCR
Egal wie das Ansprechen ist, man soll die Brust nach BET bestrahlen, immer PMRT, immer RT der LAW
Wie ist die Radiotherapie nach NACT bei frühen Mammakarzinom mit Nodalbefall zu sehen?
Prätherapeutisch cT1-2 cN1+
Posttherapeutisch keine pCR ypT1 oder ypN1
Hier soll man die Brust bestrahlen; oder PMRT; RT der LAW insbesondere wenn ein Nodalbefall nach NACT vorliegt.
Radiotherapie nach NACT
