What is the role for RNI in a postmenopausal female with clinically N+, hormone receptor positive breast cancer s/p lumpectomy and ALND with low volume nodal disease (e.g., 1/12 nodes positive)?

Z11 and AMAROS tell us that in cN0 patients, an adequate ALND is considered definitive treatment, but what about patients who have low volume biopsy proven cN1 disease? Do you treat with high tangents? Addition of just a SCV field? Or would you treat comprehensively to include SCV and IMN fields? Does age play a role in your decision?

Answer from: Radiation Oncologist at Academic Institution

When thinking about low volume nodal disease in cN+ patients, I tend to think about MA20 which included patients undergoing an ALND and 85% had 1-3 LN involved. I will offer these patients adjuvant RT to the breast and RNI (SCV/axilla with consideration of IM nodes based on dosimetry) based on the i...

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Radiation Oncologist at Hollings Cancer Center, Medical University of South Carolina
If no high-risk features are present in the low-vo...

Answer from: Radiation Oncologist at Academic Institution

Whether a patient is clinically node negative or node positive is sometimes more related to the extent of the workup performed, rather than inherent differences in biology/prognosis. For instance, a women who has a breast MRI which picks up a small level I axillary LN that is subsequently biopsied (...

Answer from: Radiation Oncologist at Academic Institution

I think @Chirag S. Shah and @Naamit K. Gerber are a little too reticent in their recommendation for RNI in a patient with 1 positive axillary node. In addition to the data cited from MA-20 one should consider all the PMRT data which has convincingly demonstrated the value of RT for pts with 1-3 pos ...

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What is the role for RNI in a postmenopausal female with clinically N+, hormone receptor positive breast cancer s/p lumpectomy and ALND with low volume nodal disease (e.g., 1/12 nodes positive)?

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