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Breast Cancer • Radiation Oncology
What is the management of residual bulky (~ 2cm) internal mammary lymph node metastasis from breast cancer after neoadjuvant chemotherapy?
Would you have CT surgery resect the mass, followed by adjuvant radiation?
Answer from: Radiation Oncologist at Academic Institution
This is relatively uncommon in our practice. However, if there is residual bulky IM adenopathy after chemotherapy, my first question would be whether or not there might be another systemic agent to consider trying before the patient goes to surgery. I would lean toward this approach when feasible.
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Answer from: Radiation Oncologist at Community Practice
I agree with @Benjamin D. Smith. The issue is if the node is persistent after chemo, it speaks to the biology of the disease with a high risk of systemic relapse. I would treat with RT, with a boost to the node after optimal systemic treatment.