60yr old female, no medical comorbidity, cT2N1M1..skin tethered, Small breast to tumour ratio, strongly ER/PR positive, Her2Neu negative, Ki67 8-10%, oligometastatic with single L 1 vertebral lesion... In addition to Zolinderonic acid with +/-RT to L1, how wud u proceed? Patient is keen on breast conservation
1) Upfront surgery with reconstruction
2) NACT followed by surgery as HT is slow to work
3) NAHT followed by surgery as strongly ER/PR positive
Option 2: NACT followed by surgery as HT is slow to work
The recent trials and literature have supported NAHT in strongly ER/PR cases with low Ki67..
Thank u for that elaborate answer...there r still a few grey zones in treating this category...
Ki67was done in our own lab which is a standard lab though we don't get ITL ratios routinely on core biopsies
Vit D is generally low in our population and given the fact that various studies are proving its protective role in a few Cancers especially Breast cancer, I get it done routinely for all my patients. And additionally when we r putting them on aromatase inhibitors
For her local bone lesion planning RT alongside breast RT
There was a very informative article written by 2 Indian physicians in NCBI... They say "Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population. In India, widely consumed food items such as dairy products are rarely fortified with vitamin D. Indian socioreligious and cultural practices do not facilitate adequate sun exposure, thereby negating potential benefits of plentiful sunshine"
Hence these low levels... Here we recommend 60000IU sachet every week to 3 week to injectable Vit D3...depending upon the levels
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