How would you manage a patient needing PMRT with a history of severe burn to the chest?

In these cases, its important to consider risk and benefit. I would also discuss with the plastic surgeon with respect to skin flap.

If the patient has advanced disease, I would offer PMRT, but counsel patient on increased toxicity risk and risk of infection. I would try to quantify improvement in locoregional recurrence and potential for survival benefit balanced against this.

In terms of technique, I would use standard fractionation. If the skin is not considered at high risk, I would consider not using bolus or reducing the number of fractions with bolus.