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August 2016

Internal Mammary Node Radiation in Light of the EORTC 22922 and MA.20 Trials—What Have We Really Learned?

Author Affiliations
  • 1University of Nebraska Medical Center, Department of Radiation Oncology, Omaha
  • 2University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, Pennsylvania
JAMA Oncol. 2016;2(8):992-993. doi:10.1001/jamaoncol.2015.5810

Radiotherapy to the internal mammary nodes (IMNs) is among the most controversial and polarizing issues in radiation oncology, owing to conflicting data and the need to delineate a balance between potential outcome benefits and cardiopulmonary toxic effects. Though occult IMN involvement is higher in patients with tumors larger than 2 cm, younger women, and patients with axillary metastases, previous randomized clinical trials (RCTs) of mastectomy (without radiation and/or systemic therapies) failed to demonstrate survival benefits with IMN dissection.1 With the recent publication of 2 large RCTs of regional nodal irradiation (RNI) therapy, the status of this debate becomes murkier.

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