How would you manage an isolated nodal recurrence of breast cancer in a patient with a prior history of mantle-field radiation?
The clinical details of the patient's "initial" radiation-associated breast cancer and what adjuvant treatment(s) she received after her mastectomy and reconstruction would be helpful here, both in determining the risk of the nodal recurrence she has now experienced and what additional therapies she...
Nodal recurrences, especially in unresectable regions, are especially challenging cases in the context of reRT. At a high level, the first thing to think about is resectability. If resectable, the usual approach is surgery, then adjuvant RT to unirradiated areas, and adjuvant chemotherapy. If unrese...
Since en-bloc excision has been done, I would favor RT for microscopic disease to the chest wall, regional nodes, including IMN, respecting heart and brachial plexus constraints. Dose 1.2 or 1.5 Gy BID to 45 Gy EQ2 or so.