Post-Op CW for 1-3 LN

She has _ of _ lymph node positive on her axillary lymph node dissection. NCCN guidelines recommend post-operative radiation for patients with positive axillary lymph node with class I evidence. The use of post-operative radiation for patients with 1-3 positive axillary lymph nodes positive is controversial in US with some U.S. reries showing lower local recurrence rates than was shown in the randomized trials at British Columbia and Danish. Randomized trial from British Columbia and Danish have reported 20-30% reisk of recurrenc in the chest wall for patients with 1-3 LN+.

Additionally it is known that larger tumor size also increases the risk of chest wall recurrence. Her tumor size of ___ is under 5 cm which is generally considered the cut off for post-operative radiation. However, given both of the risk factors above I feel her risk of CW recurrence is large enough to warrant post-operative radiation therapy. This was communicated with the patient and she stated understanding.

Complications of therapy including
Skin, Soft Tissue and Bone

  • dermatitis and necrosis of skin and fat
  • leading to telangiectasia and fibrosis

Arm Edema and Arm Function

  • 3% with Leve I/II dissection and SC field only.

Brachial Plexopathy

  • .4% with ≤ 50 Gy without chemotherapy
  • 3.4% with chemotherapy

Pulmonary Effects

  • fibrosis
  • pneumonitis

Cardiac

  • pericarditis
  • MI

Carcinogensis

  • rare

Were discussed with the patient. She would like to go forward with radiation therapy.

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