Topics:
Breast Cancer • Radiation Oncology
Would you consider radiation to the axillary lymph nodes ONLY (omitting chest wall) for patients with 1-3 axillary LNs who would otherwise not receive post-mastectomy radiation (T1-2, clear margins etc) when these patients have or will undergo breast reconstruction?
Several surgeons have asked this to reduce the time to reconstruction, complications like contracture, and the possibility of re-operation/failure of reconstruction. What increased risk of chest wall failure would you qoute for your patients?
Answer from: Radiation Oncologist at Academic Institution
I am not a fan of this approach. In patients with node positive disease without a locally advanced primary, the majority of local-regional relapses are actually still on the chest wall. Perhaps there is rationale, but if I am to treat regional nodes, I would include the chest wall. I have occasional...
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Answer from: Radiation Oncologist at Community Practice
In AMAROS study they allowed RNI without chest wall RT in RT arm. In practice if we feel patient doesnt need PMRT ( meaning chest wall) then favor dissection over RNI. That being said it is reasonable alternative if understands risk and benefit with either approach (RNI vs. ALND)
Answer from: Radiation Oncologist at Academic Institution
Agree with @Bruce G. Haffty. Though allowed in AMAROS, I do not recommend treatment to axilla only but will always include chest wall if no previous RT.
It is important in my opinion to focus on oncologic outcomes first (covering chest wall due to risk of locoregional relapse).