A 49-year-old woman undergoes simple mastectomy for a 5 cm grade 3 invasive ductal carcinoma with metastases in 5 of 14 axillary nodes. The tumour is ER-positive and HER2-negative. Which intervention provides the greatest reduction in her risk of locoregional recurrence?

• A Adjuvant letrozole alone
• B Annual surveillance imaging only
• C Extended axillary lymph node dissection
• D Post-mastectomy radiotherapy to the chest wall and regional nodes ✓

Explanation

Post-mastectomy radiotherapy is indicated for T3 or T4 primary tumours and for involvement of four or more axillary nodes, because it substantially reduces locoregional recurrence and improves survival in these high-risk groups. Endocrine therapy with letrozole reduces distant relapse but does not adequately protect the chest wall and draining nodal basins. Further axillary surgery adds morbidity without improving control, and surveillance alone detects recurrence rather than preventing it.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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