What is the management of residual bulky (~ 2cm) internal mammary lymph node metastasis from breast cancer after neoadjuvant chemotherapy?

This is relatively uncommon in our practice. However, if there is residual bulky IM adenopathy after chemotherapy, my first question would be whether or not there might be another systemic agent to consider trying before the patient goes to surgery. I would lean toward this approach when feasible.

H...

I agree with @Dr. First Last. The issue is if the node is persistent after chemo, it speaks to the biology of the disease with a high risk of systemic relapse. I would treat with RT, with a boost to the node after optimal systemic treatment.