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Ca. left Breast, pT1b N1a
The treatment Plan for such a patient in our department:
Breast +Axillary RT., with or without SCF RT as given below
Her age is >50, T1lesion, ER positive, G-1tumour. If there is no LVI, RT plan will be Whole breast Rt including level I & II axilla. Contour will be done for Level I & II axilla which will be included in the Breast field as modified tangents. Dose will be 42.7Gy/16Fr followed by supplement RT to breast tumour bed-10Gy/5Fr.
RT will be delivered by deep inspiratory breath hold method, 4D-RT, to reduce the cardiac dose
If LVI is present, then add additional field to cover axilla level-III with SCF to a dose 45Gy/20Fr
Even if Oncotype DX score is low, the plan will be the same because of N1a status
Considering the low tumor burden (T1b and only one positive lymph node) and its biologic characteristics (G1, ER/PR +), I probably would not propose the use of post-mastectomy RT. I would prescribe only adjuvant endocrine therapy
Pending Moderator approval.
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