42-year-old premenopausal women with multicentric Ca breast with strong hormone positive ( ER8+/PR7+), HER2 neg, Ki67 30-40%, with oligomers in v/o T12 vertebral involvement, who has completed all ante grade NACT ( 4AC followed by 12 #Paclitaxel), underwent MRM with risk reduction bilateral oophorectomy. Final HPE still shows ypT2N3a with 19/38 nodes positive. Post NACT PET CT revealed complete resolution of the bone lesion.
Asymptomatic for the bone lesion. What should be the current adjuvant plan: 1 RT to breast + Hormone therapy (HT) 2) RT to breast + RT bone + Zoledronic acid injection + HT 3) The benefit of additional Capecitabine with RT to breast followed by HT 4) High dose chemotherapy in v/o high nodal burden despite completion of all antegrade NACT + RT to breast followed by HT
