How would you treat recurrent unresectable skin nodules on the chest wall after mastectomy and axillary lymph node dissection?
Assume no history of radiation, no evidence of distant disease and no nodal disease on dissection. Would you treat the chest wall or the chest wall and regional lymphatics? Are there factors that would convince you to treat the lymph nodes?
Answer from: Radiation Oncologist at Community Practice
I would consider systemic treatment first based on phenotype to see if that could make it resectable.I would favor that, as surgery followed by RT would offer a better outcome.As for as RT field is concerned, I would treat chest wall and regional nodal region routinely for the recurrent disease in c...
Comments
Radiation Oncologist at Cleveland Clinic I would agree. Systemic therapy first and if they ...
Answer from: Radiation Oncologist at Community Practice
At Duke we have traditionally treated patients with gross disease after breast surgery with concurrent radiation and capecitabine. I personally have had several patients with recurrent unresectable chest wall nodules after mastectomy that have had a complete response and retain local control 5-7 yea...
Answer from: Radiation Oncologist at Academic Institution
Prognosis of local recurrence on the chest wall following mastectomy is dependent on several factors including time to recurrence, nodal status at diagnosis, ER status, prior systemic therapy received, prior RT and importantly surgical resectability at time of local recurrence. 10 year FFS ranges fr...
Answer from: Radiation Oncologist at Community Practice
If surgery were clearly not possible, then it depends whether the intent is curative or palliative.
In the setting described, it sounds potentially curative. If that is the case, then would there be a role for some combination of external beam radiation with HDR mold brachytherapy? Chemotherapy cou...
Answer from: Radiation Oncologist at Community Practice
My inclination is to treat the chest wall only, primarily because this is most likely systemic (even if you can't find it) and incurable. This makes treatment a little easier on the patient and you can always treat the nodes later, if necessary.
I would agree. Systemic therapy first and if they ...