Would you recommend axillary dissection for a patient with a clinically positive SCV or IMN node, who has a clinical CR to neoadjuvant chemo, but a positive SLNB?

Topics: Breast Cancer • Radiation Oncology

Does it make sense to resect only the axillary nodes, but not the other involved nodal regions? Regional nodal radiation will be given.

Answer from: Radiation Oncologist at Community Practice

My approach for this is to treat comprehensively with RT and boost any visible node/location where the prechemotherapy node existed and was not removed at surgery.

Comments

Radiation Oncologist at Kaiser Permanente
Thank you. But would you advise for or against an...

Radiation Oncologist at Varian Medical Systems/Allegheny health network
i don't push for dissection if had CR as we are no...

Answer from: Radiation Oncologist at Academic Institution

This is a great question that I have seen many times clinically. The point is often made that Z-11 did not include such patients and therefore the logic to omit ALND with limited SLN positivity is inappropriately applied. However, the true question may be whether radiation can eradicate disease in t...

Answer from: Radiation Oncologist at Academic Institution

With positive SLNB after neoadjuvant chemotherapy, I would favor dissection even if plan was to treat comprehensively afterwards. I understand that we don't dissect SCV or IMs routinely but standard practice has been to do ALND. I would boost undissected nodes in SCV/IM.

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