Perspectives on Postmastectomy Radiation Therapy for Persistent Nodal Disease After Neoadjuvant Chemotherapy: Is Hindsight 20/20?

Postmastectomy radiation therapy (PMRT) generally improves locoregional control and overall survival in patients with pathologic lymph node-positive breast cancer, as evidenced by meta-analyses of randomized trials (1). Nevertheless, controversy persists regarding whether PMRT is indicated for all such patients, especially those with clinical T1-T3N1 who receive neoadjuvant chemotherapy (NAC) with a complete pathologic response in the involved axillary lymph nodes (ypN0). For such patients, the current standard recommendation is to offer entry into clinical trials comparing regional nodal irradiation (RNI) versus no RNI (2), such as the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-51/Radiation Therapy Oncology Group 1304 trial.

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