Is There a Role for Postmastectomy Radiation Therapy After Complete Pathologic Response to Neoadjuvant Chemotherapy?
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- Housri, N. & Haffty, B.G. Curr Breast Cancer Rep (2014) 6: 38. doi:10.1007/s12609-013-0134-8
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Patients with locally advanced breast cancer who undergo neoadjuvant chemotherapy and who are found to have a pathologic complete response (pCR) at the time of mastectomy pose a unique challenge to the radiation oncologist. Whereas patients with node-negative disease and small primary tumors treated immediately by mastectomy do not generally require postmastectomy radiation (PMRT), radiation indications are unclear for patients who present initially with more advanced disease and become node-negative after chemotherapy. Consequently, guidelines and patterns of practice for PMRT after neoadjuvant vary substantially among institutions and clinicians both nationally and internationally. Although some retrospective data suggest that patients with a pCR are at low risk of local failure and may not require adjuvant PMRT, there are conflicting data suggesting a role for PMRT, depending on the initial clinical stage at presentation. A national multi-institutional trial is currently investigating this question.