What's the post BCS current guideline ?

[abish]

First of all, I'm not sure if I should ask these sort of questions here.
(Sorry if I posted it in wrong place)

Here's the problem.

58/F Postmenopausal. Rt Breast Cancer.
Post BCS
IDC Gr 2. 2 cm.
8/12 LNs involved.
ER positive. Her2 awaited.

What would you do further ?
1. Further investigations ?
2. Radiotherapy ? - Fractionation Schedule ?
3. Chemotherapy ? Which ? Why ?
4. Hormonal Therapy ? Which Why ?
5. Follow up ?

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[Gfunk6]

First of all, I'm not sure if I should ask these sort of questions here.
(Sorry if I posted it in wrong place)

Here's the problem.

58/F Postmenopausal. Rt Breast Cancer.
Post BCS
IDC Gr 2. 2 cm.
8/12 LNs involved.
ER positive. Her2 awaited.

1. Further investigations ?

I'd want to know more about her surgical margins. Were they positive? close? clear? Also, I'd like to know if she had ECE in her LNs.

Given that she has pT2N2a (IIIA) disease, I think it would be prudent to perform a PET/CT and MRI brain to r/o distant mets before proceeding with further therapy.

2. Radiotherapy ? - Fractionation Schedule ?

I'd do 50 Gy to her whole R breast, SCV, and dissected axilla. I don't treat IMNs if they are not clinically positive but I'm sure others would disagree. Also would boost her resection cavity to 60 Gy.

3. Chemotherapy ? Which ? Why ?

It depends if she is HER2 positive, in which case Herceptin would be indicated [NSABP B-31 + NCCTG N9831]. Otherwise, she should probably get a taxane since it improves OS in node-positive cancers [Intergroup 0148 / CALGB 9344]. Given her extensive nodal disease, I would be in favor of dose dense AC and T if she can take it [Intergroup / CALGB 9741].

4. Hormonal Therapy ? Which Why ?

Aromatase Inhibitor x 5 years [ATAC trial]

Since you are a newbie, I'd suggest perusing NCCN guideliens for breast cancer.

 

[hot sauce]

First of all, I'm not sure if I should ask these sort of questions here.
(Sorry if I posted it in wrong place)

Here's the problem.

58/F Postmenopausal. Rt Breast Cancer.
Post BCS
IDC Gr 2. 2 cm.
8/12 LNs involved.
ER positive. Her2 awaited.

What would you do further ?
1. Further investigations ?
2. Radiotherapy ? - Fractionation Schedule ?
3. Chemotherapy ? Which ? Why ?
4. Hormonal Therapy ? Which Why ?
5. Follow up ?

You should probably check out nccn guidelines (nccn.org - you can register for free) or an oncology textbook. People are generally glad to help out but usually a more focused questions regarding something you are trying to understand rather than just asking us to explain everything (not to be mean but it sounds like this is where you turned first).

A brief answer to some of your questions.

(Assuming no neoadjuvant chemo and clear margins). Node positive breast cancer you are going to give chemo (I'd guess AC + T but I'm not a med onc) followed by standard fractionation RT to the entire breast and lymph nodes (axillary, supraclav, and possibly internal mammary nodes depending on quadrant of primary and institutional preference) and then an AI. This is a pretty standard unless there is a contraindication.

An argument could be made for additional imaging to evaluate for distant metastatic disease but I don't know what she has already had.

 

[abish]

Thank you!