How would you approach an isolated supraclavicular nodal recurrence of breast cancer in a patient who was treated with breast conserving surgery and whole breast radiation without RNI?

I think there are several approaches:

1. Surgically resectable: not always offered, but can consider staging, consideration of neoadjuvant chemotherapy and surgery, followed by adjuvant RT. If more than 2 years from original RT, I consider comprehensive treatment (standard or hyper fractionation) vs...

The goal would be definitive. Sequencing and modality of treatment is based on phenotype and size and extent of nodal disease (systemic treatment and RT with or without surgery).

Check internal mammary nodes first if involved, then treat supraclavicular with a field matched well possible small boost cover internal M nodes if affected, PEt-Ct are very helpful