In what circumstances would you offer axillary re-irradiation after salvage axillary dissection?

A study from many years ago found no further axillary recurrences in 4 patients who had gross total excision of axillary recurrences following initial breast-conserving therapy, including RT and axillary dissection, with a median follow-up of 28 months (Recht et al., PMID 2033433). However, there is almost nothing on the subject of further axillary or regional nodal recurrence for patients undergoing salvage axillary dissection for recurrence after SLNB. A study using the ECOG data-base of patie...

This is a tough situation, but one that we encounter more often than we would like!

Although there have been studies examining conventional fractionation to 45-50 Gy in the re-irradiation setting [to the chest wall (post-mastectomy) and/or regional nodal regions], in the axillary re-irradiation setting, I would instead consider hyperfractionation (~45 Gy in 30 BID fractions, as per RTOG 1014) in order to try to minimize the risk of brachial plexopathy, with the brachial plexus as the OAR at great...