Noa Efrat (Ben-Baruch), MD Oncologist License No. 15606 Specialist license No. 10084 Impression and Recommendations: Very slow progression of metastatic breast cancer with little metastatic spread. At the present time, the main problem is a mechanical one of T1 vertebra. If she refuses surgery, | would consider focused stereotactic radiation to T1. Regarding the oncology treatment plan: - Continue taking Letrozole + ovarian suppression + Xgeva - Systemic evaluation after 4 months of therapy - Axillary US and tumor markers after 3 months of therapy Sincerely, Noa Efrat (Ben-Baruch), MD Noa Eftrat Ben-Baruch Oncologist Director, Oncoogy Institute Kaplan Medical Center Medical license 15605 Specialist License No. 10084 [doctor's stamp] Director, Oncology Institute Kaplan Medical Center Rehovot AM.3 EFTA00587651