Are there additional risks associated with PMRT for a patient with prior lympho-venous bypass surgery?

If a patient is found to have 2 lymph nodes positive with ECE s/p mastectomy, axillary dissection, tissue reconstruction, and lympho-venous bypass surgery, are there additional risks associated with delivery of PMRT? Would the presence of tissue reconstruction and lympho-venous bypass ever impact your dose/fractionation or PMRT field design in this case?

2 Answers

Mednet MemberInvited Expert

Radiation Oncology · Varian Medical Systems/Allegheny health network

Answered on

Based on FABREC, we do offer hypofractionation after reconstruction and focus on plan quality with dose homogeneity and very selective use of bolus.

RT CHARM will further clarify.

LV bypass helps to reduce lymphedema risk and we don’t change fractionation based on that.

Conroy, Cancer Network 2023

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Mednet MemberInvited Expert

Radiation Oncology · Northwestern University Feinberg School of Medicine

Answered on

There are two studies I am aware of, specifically addressing the location of LV bypass in relation to different RT fields - Spiegel et al., PMID 37141983 and Naoum et al (abstract Astro 2022).

While we found that in both studies the bypass is usually located in level-1 & 2 mainly, there was no direct...

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