For locally advanced breast cancer, to what dose do you treat undissected clinically positive level III axilla, SCV or IM nodes?

At MD Anderson Cancer Center, we systematically stage the regional nodes using ultrasound. We biopsy suspicious nodes with FNA at the time of ultrasound. Given this systematic approach to staging, we have a large experience treating patients with biopsy-confirmed infraclavicular, supraclavicular, an...

The approach suggested by @Dr. First Last and @Dr. First Last is quite reasonable; and boosting any un-dissected but previously involved nodal basin to 60 Gy, assuring that the 90% isodose line is covering disease and respecting the brachial plexus as suggested, is a rational approach that should re...

Our approach is very similar. Any undissected pretreatment involved node we treat to higher dose. If node normalizes after chemo, then the dose is 55.8 to 59.4, and if it persists after chemo, then 59.4 to 63 Gy.

The comments of all of my distinguished colleagues above are valued, but I would like to reinforce what @Dr. First Last has said in particular. We know from solid tumor experience in many areas such as head and neck, GYN, as well as breast, that the probability of achieving local control of critical...

Agreed, in era of increasing MRI utilization, we are seeing more IM nodes on imaging that are not dissected, as well as other nodes as mentioned above. I agree with doses to 60-66 Gy. If there is substantial residual adenopathy, I have considered discussion with a medical oncologist regarding concur...

I treat these likely gross nodes to 60-66 depending on how they respond to systemic therapy (CR or breast and ax I/II PCR 60, gross residual on imaging or extensive RCB 66). N3 nodes are a reason I use VMAT, but if I am using 3D, I use photon/electron multi-iso and boost the IMC with electrons.

Often, I will deformable fuse pre neo adjuvant PET/CT to the post op CT sim and boost if I can identify the pre op nodes but often you cannot see them on the post op CT sim so I will go to 50 Gy comprehensive and boost to 60 Gy if I am confident I can indentify the pre neo adjuvant nodes.

Deformable...