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Breast Cancer • Radiation Oncology
Do you ever treat cervical nodes above the standard supraclavicular field for breast cancer patients?
For breast cancer patients receiving adjuvant breast/chest wall RT + RNI, do you ever treat cervical nodes above the standard supraclavicular field (e.g., level II/III/V) when CT/MRI/PET is suspicious but biopsy is negative or non-diagnostic?
If yes, do you extend elective coverage and/or boost the dominant node, and what findings push you to treat as oligometastatic M1 instead?
For example, in a patient with ypN3a after NAC/ALND with an enhancing 1.6 cm ipsilateral SCV node and additional suspicious level II/III/V nodes on CT, PET read as reactive; FNA scant/atypical, core/excisional bx deemed too high risk.
What would be your field design and dose/fx recommendations?
Answer from: Radiation Oncologist at Academic Institution
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 ar...
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Answer from: Radiation Oncologist at Community Practice
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 incl...
Answer from: Radiation Oncologist at Academic Institution
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 mea...
Answer from: Radiation Oncologist at Academic Institution
Good question, thanks for asking.
Yes. There are certainly many clinical situations where extending the superior border further superior (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 bounda...