Are there any indications to boost the axilla for women with locally advanced breast cancer who do not have clear gross residual/undissected axillary disease?

There is no indication for a boost in absence of undissected gross node for upfront surgery or residual node, which is not removed after neoadjuvant chemotherapy.

I do not boost the axilla for patients without gross disease/undissected disease. I do ensure that full coverage of the axilla is provided; when prescribing 50 Gy, I like to see 45 Gy completely encompassing the axilla, SCV and when prescribing 40.05, I like to see 38 Gy line encompassing.

In cases...

If no gross/undissected disease, I try to ensure 90-95% coverage depending on the risk profile.

If gross disease, I attempt to escalate to 66 Gy and consider concurrent therapy in the context of MDTB. Usually xeloda per MDA phase 2 study, but have used other radiosensitizers based on medical oncolog...