Radiation, then On to Surgery

To formulate an individualized treatment plan, we would first carefully assess the patient's goals of care and priorities. Because she (1) is not eligible for up-front surgery or preoperative chemotherapy and because locoregional progression will further impact quality of life, we would recommend neoadjuvant radiation therapy (RT) targeting the whole breast, ipsilateral axilla, and supraclavicular fossa with or without the internal mammary chain. We favor preoperative RT using definitive doses over palliative RT or supportive care alone, because this strategy is generally well-tolerated and offers the best chance for tumor shrinkage to provide durable symptom and locoregional control, potentially enabling surgical resection and reducing the risk of distant metastasis.

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