How do you approach boost to the lumpectomy cavity AND 4 lymph nodes with extra-nodal extension when treating breast cancer with hypofractionation?

The patient is not able to come for standard fractionation and is unable to have post operative chemotherapy or completion ALND due to insurance and social issues.

If proceeding with hypofractionation per RT CHARM, would you offer simultaneous integrated boost or sequential boost in this instance, and to what doses?

Answer from: Radiation Oncologist at Community Practice

For breast/chest wall + RNI, I have transitioned to moderate hypofractionation giving 40 Gy/15 fractions. I don't see a clear role for standard fractionation; with 4+ nodes, the question is ALND but if you are giving RT, I'm not sure I see that as an indication for standard fractionation. &nb...

Comments

Radiation Oncologist at Radiant Oncology
Would you boost the regions of ENE?

Radiation Oncologist at Munson Medical Center
Generally no boost to the area of ENE. I make sure...

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How do you approach boost to the lumpectomy cavity AND 4 lymph nodes with extra-nodal extension when treating breast cancer with hypofractionation?

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