Topics:
Breast Cancer • Radiation Oncology
How would you treat a biopsy proven isolated left-sided internal mammary node recurrence 20 years after mastectomy and chemotherapy for left breast cancer?
No prior radiation. No evidence of chest wall, axillary, or supraclavicular disease.
Answer from: Radiation Oncologist at Academic Institution
A 20 year truly isolated IMN recurrence sounds like a pretty good example of an oligorecurrence to me…
I think the historical standard of care is definitely as @Chirag S. Shah and @Sushil Beriwal have outlined above, but I wonder if it’s time to start viewing a locoregional breast...
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Answer from: Radiation Oncologist at Academic Institution
I would treat in this case. There are two strategies we have considered:
1. Definitive RT - Given no previous RT, I would treat CW + RNI to 50 Gy and boost IM node to 60-66 Gy. If previous RT, I have treated the entire IM chain to 50 Gy and the boosted involved area with margin to 60-66 Gy.
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Radiation Oncologist at AdventHealth Orlando (previously Florida Hospital)
I agree with Dr. @Chirag S. Shah. I find that surg...
I agree with Dr. @Chirag S. Shah. I find that surg...
Answer from: Radiation Oncologist at Community Practice
Management based on phenotype and volume of disease.
If her2 positive or triple-negative, can get systemic treatment first and then RT with dose tailored based on response to chemo.
If ER positive, then RT as above although, if large volume then would favor resection and then RT.