Would you consider RNI in a patient with axillary recurrence after lumpectomy, whole breast RT and cavity boost 10 years ago?

Topics: Breast Cancer • Radiation Oncology

The patient is now s/p neoadjuvant chemotherapy, mastectomy, and ALND for their ipsilateral recurrence, and pathology showing residual disease (ypT0N2).

Would you offer axillary RT in this scenario? Why or why not?

Answer from: Radiation Oncologist at Academic Institution

This patient has residual nodal disease after neoadjuvant chemotherapy and has a high risk of recurrence. I have typically treated the supraclavicular fossa and at risk axilla using a VMAT technique to limit skin dose in the area of overlap. You have 10 years of repair and the patient should tolerat...

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Radiation Oncologist at University of Miami/Jackson Memorial Medical Center
Thanks @Janice, would you consider re-irradiation ...

Radiation Oncologist at University Hospitals Seidman Cancer Center
It would depend on her clinical T stage, but likel...

Answer from: Radiation Oncologist at Community Practice

Axillary nodal disease correlates most with chest wall recurrence (60-75% of post mastectomy recurrences are along the chest wall). After a disruption (like multiple surgeries), we don’t exactly know what the recurrence pattern will be, but it is highly unlikely to change to where CW would be ...

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Radiation Oncologist at University of Miami/Jackson Memorial Medical Center
What dose and fractionation would you consider?

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