How would you approach a patient who is s/p mastectomy with only DCIS in the breast and a large positive sentinel node?

Would implant reconstruction prior to radiation therapy change your recommendations? Would you ever treat just the nodes and omit the chest wall/reconstructed breast to minimize risk of implant complications? Would age <50 influence your decision?

Answer from: Radiation Oncologist at Academic Institution

If the patient had SLN only (no ALND), I would offer adjuvant radiation extrapolating from AMAROS. While only DCIS in the mastectomy specimen, nodal involvement suggests foci on invasion. Implant reconstruction may increase the complication profile but would not change my recommendation. Age < 5...

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Radiation Oncologist at NYHQ
Great answer! Thanks

Answer from: Radiation Oncologist at Community Practice

If the only reason to treat is the macromet in one node with no other adverse factors, I would favor ALND to avoid RT, especially to avoid the effect RT on reconstruction.If the patient is unwilling to have an ALND because of the risk of lymphedema, then an additional treatment to the axilla is need...

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Radiation Oncologist at Northeast Oklahoma Cancer Center
Would the data suggesting survival and/or reductio...

Radiation Oncologist at Weill Cornell Medical College
agree with the above people. here the...

Radiation Oncologist at Cleveland Clinic
I would agree, the challenge with this case is if ...

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How would you approach a patient who is s/p mastectomy with only DCIS in the breast and a large positive sentinel node?

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