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For locally advanced breast cancer, to what dose do you treat undissected clinically positive level III axilla, SCV or IM nodes?
We sometimes find highly suspicious LNs by CT, PET or MRI in the undissected regional lymphatics, and surgeons may not be willing to perform another operation after level I-II axillary dissection. Will you boost these undissected grossly involved nodes to a higher dose? If so, what dose and how is the boost delivered?
Answer from: Radiation Oncologist at Academic Institution
At MD Anderson Cancer Center, we systematically stage the regional nodes using ultrasound. We biopsy suspicious nodes with FNA at the time of ultrasound. Given this systematic approach to staging, we have a large experience treating patients with biopsy-confirmed infraclavicular, supraclavicular, an...
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Answer from: Radiation Oncologist at Academic Institution
The approach suggested by @Benjamin D. Smith and @Sushil Beriwal is quite reasonable; and boosting any un-dissected but previously involved nodal basin to 60 Gy, assuring that the 90% isodose line is covering disease and respecting the brachial plexus as suggested, is a rational approach that should...
Answer from: Radiation Oncologist at Community Practice
Our approach is very similar. Any undissected pretreatment involved node we treat to higher dose. If node normalizes after chemo, then the dose is 55.8 to 59.4, and if it persists after chemo, then 59.4 to 63 Gy.
Answer from: Radiation Oncologist at Academic Institution
The comments of all of my distinguished colleagues above are valued, but I would like to reinforce what @Chirag S. Shah has said in particular. We know from solid tumor experience in many areas such as head and neck, GYN, as well as breast, that the probability of achieving local control of critical...
Answer from: Radiation Oncologist at Academic Institution
Agreed, in era of increasing MRI utilization, we are seeing more IM nodes on imaging that are not dissected, as well as other nodes as mentioned above. I agree with doses to 60-66 Gy. If there is substantial residual adenopathy, I have considered discussion with a medical oncologist regarding concur...