For a breast cancer patient who previously underwent lumpectomy/SLN biopsy and PBI with brachytherapy, what volume would you treat for an isolated axillary recurrence s/p ALND and chemo?

Since only part of the breast was treated before, would you include treatment of the whole breast now, despite no detectable disease?

Answer from: Radiation Oncologist at Academic Institution

How long has it been since initial brachytherapy? If > 2 years from initial treatment, I typically will treat breast/chest wall and regional nodes. If < 2 years, I would consider regional nodes only; however, would also look at the original plan as some UOQ PBI cases may give a dose to the a...

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Radiation Oncologist at Texas Oncology
Would you alter the dose at all in those settings?

Radiation Oncologist at Cleveland Clinic
I typically do not and give 50 Gy /25 fx. However,...

Radiation Oncologist at Cleveland Clinic
In cases > 5 years out, I have also used hypofx...

Answer from: Radiation Oncologist at Community Practice

This most likely reflects a false negative SNLN which is uncommon but can present with a delayed axillary recurrence. I would get a breast MRI as part of the workup to rule out concurrent IBTR or new primary in the breast. If it is negative, I would recommend ALND followed by RT to the undissected a...

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For a breast cancer patient who previously underwent lumpectomy/SLN biopsy and PBI with brachytherapy, what volume would you treat for an isolated axillary recurrence s/p ALND and chemo?

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