Breast cancer
UPDATED --- Radiotherapy for early breast cancer

Tina (37 years old)

Tina, 37 years old, runs a cat hotel and loves to spoil the cats when their owners go on vacation. She was diagnosed with right-sided luminal B-like cT2N1M0 breast cancer after she felt a palpable lump in her right axilla.

Assessment summary

  • No relevant medical history
  • Premenopausal
  • Genetic counselling + testing (positive family history): no BRCA1/2 germline mutations
  • Tumour biology (core biopsy): G2, invasive carcinoma of NST, ER 100%, PgR 10%, HER2 IHC 2+ SISH negative, Ki67 50%
  • FNAC axillary node: positive
  • Tumour location: laterally in the breast
  • Neoadjuvant chemotherapy: dose-dense EC q2w with G-CSF support, followed by dose-dense paclitaxel q2w
  • Breast MRI at post-neoadjuvant therapy:
    • Partial response in breast (19 mm nodule) and complete response in axilla (ycT1cN0)
  • 3 weeks later: BCS with minor reconstructive techniques and limited ALND
    • 19 mm foci, G2, invasive carcinoma of NST
    • Lymphovascular invasion
    • R0 resection
    • 1 macrometastasis and 1 micrometastasis (2/6 lymph nodes)
    • ypT1cN1a
  • Patient will be treated with RT (whole-breast RT + boost) and hormonal therapy

Which radiotherapy option would you choose for this patient?