Do you ever treat cervical nodes above the standard supraclavicular field for breast cancer patients?

In the setting of biopsy-proven supraclavicular or cervical nodal disease, I do extend my fields cranially to include these nodes. I typically include the entire neck level based on head and neck contouring atlases and extend the cranial border at least 1 cm superior to the highest node. If nodes are suspicious but not biopsy-proven, would make the judgment based on the clinical suspicion (i.e., how radiographically suspicious, what is pre-test probability given other risk factors, etc.), and if...

I generally follow the principle to treat one level above and lateral to the involvement. So, if medial s/c is positive (level 4 neck node) would include adjoining level 3 (cranial) and level 5 (lateral s/c). So, for the case described, a large nodal burden based on the index of suspicion would include cervical nodes and a boost to a higher dose if persistent after NAC.

I similarly agree with the previous answers and would share that sometimes what radiologists are calling cervical lymph nodes on their formal read would be encompassed by our traditional supraclavicular contours, and/or the cranial extent to cover the suspicious and/or involved node(s) would not meaningfully change our usual fields.

This is a small paper with all the caveats of a retrospective series, but it lends support to treating patients with cervical nodal involvement with aggressive locor...

Good question, thanks for asking.

Yes. There are certainly many clinical situations where extending the superior border further superiorly (compared to our standard) is very reasonable; e.g., when there is suspected or proven, supraclavicular nodal disease. It is important to remember that our boundaries of nodal groups are often somewhat arbitrary (e.g., the axilla versus supraclav, the supraclav vs. cervical, etc.).

In general, I believe the added morbidity from extending the supraclavicular ...

I agree with and follow the same approach and technique as Dr. @Dr. First Last has described.