Onco Life Hospitals

Book PET CT Scan Appointment
Book Doctor Appointment
Cancers Information
Facebook Twitter Youtube Instagram Linkedin

A Precise Second Win: Treating an Internal Mammary Node Recurrence in Triple-Negative Breast Cancer

  • Home
  • A Precise Second Win: Treating an Internal Mammary Node Recurrence in Triple-Negative Breast Cancer

Meet the patient

A 47-year-old woman was diagnosed with right-sided triple-negative breast cancer. Staging showed localised disease. She underwent a modified radical mastectomy (MRM). Pathology: T2N1, triple-negative, an aggressive subtype that usually needs comprehensive therapy. She received adjuvant chemotherapy (8 cycles), followed by radiation to the right chest wall and supraclavicular fossa: 40 Gy in 15 fractions over 3 weeks. She then moved into follow-up.

Nine months later: a faint spark on the scan

On routine PET-CT, a single, isolated hotspot appeared in the right internal mammary node (IMN)—with no disease elsewhere. A gut-punch moment, but also a clearly defined target.

Tumour board huddle: the smartest next step

The case went to the multidisciplinary tumour board. Local options considered: surgery vs radiation. Surgery wasn’t chosen, so the team planned high-precision re-irradiation to the IMN. Because she’d been irradiated just months earlier, safety demanded meticulous planning.

Planning around yesterday’s dose to treat safely today

The previous 3D-CRT tangential plan was imported and fused with the new planning CT. The radiation oncologist and physicist reviewed the dose already delivered at the IMN site and the cumulative exposure to organs at risk (OARs). Prescription: 40 Gy in 15 fractions to the recurrent IMN, delivered with IG-IMRT (image-guided, intensity-modulated radiotherapy) for millimetre-level accuracy and daily image verification.

In plain English: we overlaid the old radiation “footprints” onto the new map so we could hit the recurrence precisely without overdosing nearby normal tissues.

How she did

She tolerated treatment well with no acute morbidity. Daily image guidance kept the target centred and protected normal tissues.

The result that matters

At 3 months post-IMN radiation, PET-CT showed a complete metabolic response—the hotspot was gone, and no other disease was seen. She remains disease-free on follow-up at 10 months (and counting).

Why this worked (story logic)

  1. Early, focused detection: a single, isolated IMN recurrence gave a precise target.
  2. Smart re-planning: fusing the old plan to the new CT respected cumulative dose and safeguarded OARs.
  3. Modern technique: IG-IMRT provided beam-shaping and daily imaging for safe re-irradiation.
  4. Measured prescription: 40 Gy/15 balanced tumour control with normal-tissue safety.
  5. Tight follow-up: Early post-RT PET confirmed success; continued surveillance maintains it.

The bigger message

Breast cancer isn’t one disease; triple-negative can be fierce. Yet even after previous radiation, a well-selected, precisely planned second course can be feasible and effective when recurrence is localised and the team rigorously accounts for cumulative dose. With timely scans, clear tumour-board decisions, and precision tech, a setback can become a second victory.

Clinician snapshot (drop-in ready)

  • Dx: Right breast TNBC, T2N1; localised at presentation
  • Primary treatment: MRM → adjuvant chemo ×8 → RT CW+SCF 40 Gy/15# (3 weeks)
  • Interval: 9 months post-RT → isolated right IMN recurrence on PET-CT
  • Decision: Local tumour-directed therapy; surgery not chosen → re-irradiation planned
  • Prior plan: 3D-CRT tangents; prior dose & OARs imported/fused to new CT for cumulative evaluation
  • Salvage plan: IG-IMRT 40 Gy/15# to IMN; daily image guidance
  • Toxicity: Well tolerated; no acute morbidity
  • Response: PET-CT at 3 months → complete metabolic response; no other disease
  • Status: Disease-free at 10-month follow-up