ASTRO 2026: Dr. Erica Braschi Jordan Details Proton Regional Nodal Care Plan

At the American Society for Radiation Oncology (ASTRO) 2026 Annual Meeting, radiation oncology researchers highlighted the vital role of structured toxicity monitoring in optimizing survivorship outcomes for patients with breast cancer.

In an on-site interview with Oncology Nursing News, Erica Braschi Jordan, MD, PGY-5 Radiation Oncology Resident at the University of Florida in Gainesville, detailed clinical strategies for managing side effects in patients receiving adjuvant proton therapy for regional nodal irradiation.

Braschi Jordan emphasized that integrated nursing workflows are essential to identify acute toxicities early and prevent long-term functional impairment.

Key Takeaways for Oncology Nursing Practice

• Routine On-Treatment Surveillance: Establishing standardized weekly toxicity assessments from week 1 of radiation therapy enables precise tracking of acute adverse events.
• Graded Toxicity Documentation: Utilizing standardized grading systems provides an objective baseline to monitor symptom progression during treatment and follow-up visits.
• Proactive Lymphedema Screening: Patients receiving regional nodal irradiation following axillary surgery face elevated risks for lymphedema and restricted range of motion.
• Multidisciplinary Rehabilitation: Timely referral to physical therapy and supportive care services mitigates functional decline and preserves patient quality of life.
• Multimodal Treatment Context: Recognizing the cumulative impact of surgery, chemotherapy, and radiation helps care teams address complex, multi-system toxicities.

Implementing Integrated Toxicity Tracking Workflows

Adjuvant proton therapy for regional nodal irradiation offers precise dose conformity, but patients remain at risk for acute cutaneous and musculoskeletal toxicities. Braschi Jordan noted that on-treatment visits offer a vital window for systematic nursing assessments.

"I think on treatment visits are an excellent time to track those toxicities, especially in the acute setting," Braschi Jordan stated. "So to have an integrated workflow that is just routine, every time the patient comes on a weekly basis during their treatment you're recording toxicity from week 1 and onward, and really tracking the progression of any toxicity that comes up."

In addition to acute surveillance, Braschi Jordan underscored the necessity of structured follow-up evaluations using standardized grading tools to identify late-emerging treatment effects.

"Similarly, doing any patient follow-ups, making sure that you are asking about late toxicities," she explained. "And it's helpful when you have the graded system, so you know exactly what toxicity they're experiencing and how to grade it over time."

Addressing Quality of Life and Multidisciplinary Interventions

Regional nodal irradiation encompasses complex anatomical volumes, particularly among patients who have undergone axillary lymph node dissection or systemic chemotherapy.

"Especially in this setting where we're talking about patients with adjuvant proton regional nodal radiation, these patients are at high risk of developing lymphedema, limited range of motion in the area where they had axillary surgery and then radiation," Braschi Jordan said.

To mitigate these toxicities, Braschi Jordan advocated for early functional evaluation and prompt referral to supportive specialties.

"How is their quality of life affected by these toxicities? How are they recovering from these treatments and can we plug them in to maybe physical therapy or are there medications we can give to help?" Braschi Jordan concluded. "It takes a team to help a patient not just treat their cancer, but also helping with dealing with the side effects and toxicity from those treatments."

References

1. Braschi Jordan E, et al. Navigating Nodes: Outcomes of Proton Therapy for Regional Nodal Irradiation in Breast Cancer. Abstract 2704. Presented at: American Society for Radiation Oncology (ASTRO) 2026 Annual Meeting; September 28, 2026; Boston, MA.