A radiation oncology expert witness advises on a case involving a patient who was diagnosed with left breast cancer and underwent surgery to remove the tumor, which had spread into two lymph nodes in her armpit. The cancer in both lymph nodes had grown so quickly that it had broken through the capsule of the lymph nodes and was spreading into the surrounding tissues. The patient then received chemotherapy, followed by intraoperative and regular radiation therapy. The regular radiation therapy was prescribed and administered by defendant doctor.
Eight months later, the patient began to experience weakness and numbness of the left hand and arm. A PET/CT scan showed a small area of suspicious activity in the area of the surgical clips in the armpit. This was the identical area where the post-surgery pathology report had demonstrated extra nodal extension. An MRI showed a 2.0 by 1.5 by 2.0 cm mass in the L axillary neurovascular bundle which correlated with the abnormal PET/CT scan and was consistent with re-growth of tumor in the left armpit. This tumor was removed. The pathology was consistent with the same breast cancer. She underwent additional chemotherapy and additional radiation therapy directed to the tumor.
Several months later, a PET/CT scan showed metastatic cancer within both lobes of the liver. She continued to develop significant spread of the breast cancer to the brain and spine and she died.
The woman’s family sued the defendant for negligence, alleging she breached the standard of care by failing to adequately treat her breast cancer with radiation.
Question(s) For Expert Witness
- 1. Did the defendant correctly apply radiation?
- 2. Was the defendant’s failure a proximate cause of the woman’s death?
- 3. Did the defendant breach the standard of care?
Expert Witness Response
I have reviewed the radiation therapy records from the first treatment to the breast and draining lymphatics prescribed and directed by defendant. I have found significant flaws in the radiation plan, and in the radiation treatment given to the plaintiff. The radiation plan as performed by defendant shows an area approximately 1.5cm in width that was not treated at all with radiation. This area of non treatment is exactly where the surgeon had purposely left the axillary clips, because he was worried about any residual tumor being left behind. The net result of these errors in radiation therapy design was essentially that no treatment was given to the area most likely to have residual cancer.
As a direct consequence of faulty radiation therapy treatment design, the patient’s cancer came back. This failure to treat the area outlined by the surgeon with the placement of clips was a negligent act or omission that was the proximate cause of the recurrence of the cancer and the ultimate death of the patient.
As a direct result of not adequately treating the cancer in the armpit, the cancer persisted there, and then later spread widely to many other parts of her body which resulted in her death. Based upon the foregoing, it is my opinion to a reasonable degree of medical probability that the care rendered by the defendant fell below all applicable standards of care in the field of radiation oncology.
The expert is board certified in radiation oncology and has extensive inpatient and outpatient radiation oncology experience.