She is T4aN0 minimum, and my recollection that is that that falls over the line for comprehensive RT. Not only is the SCF at riak but so are interpectoral nodes.

A. If Axillary nodes were involved . She definitely needs 3 Field (include SCF) in RT Field.

B. If Axillary nodes were not histologically verified. Its a tough decision then. I would err on the side of caution and give SCF RT.

Reasons:

1. She is 32 yrs.
2. The anticiapted side-effects, risks of hypothyrodism is miniscule
3. Incidence of Late malignancy is there, but low (but she must first survive this breast ca first, to be alive)
4. Not much added toxicity of additional Rx with SCF.
5. The Surgery sterilises the axilla, however the scf is not addressed by surgeon (could be a late sanctuary site of relapse)
6. Go for an ALL out blow to her cancer (Now or never)

C. If we knew axillary nodes were negative (cytology / histology), i would not treat SCF then.

I m sure, harsha that this lady was appropriately staged with CT scan & Bone scan prioir to her chemo.
ER/PR/Her2 status would b known and these will be addressed accordingly.