In the setting of recurrent breast cancer after breast radiation, who receives a mastectomy and is found to have positive axillary nodes, under what circumstances would you give radiation to the chest wall and nodes vs the nodes only?

There is no absolute answer, and it is a function of time to recurrence, previous volume of RT, and potential benefit of RT (based on extent and location of recurrence and phenotype of disease). The threshold to treat is higher than upfront setting for sure.

Treatment can vary from none to comprehensive PMRT. The patient needs to warned about higher risk of fracture, chest wall necrosis, and significant skin changes, including diffuse telangiectasias of the skin. I usually use 45 Gy in 25 fracti...

There is no definitive answer and from my experience significant differences in approaches based on institution.

For me, if the patient is > 2 years from initial breast radiation, I will offer treatment to the chest wall and regional nodes. Regimens considered can be hyperfractionation, hypofractionation (I use when > 5-10 years from first course, 40/15).

If < 2 years from initial breast radiation, I consider treatment to the nodes only particularly if there is axillary only failure. However, I ...