Should all women with positive nodes in breast cancer receive comprehensive nodal irradiation?—Yes.
For decades, irradiation of the regional lymph nodes was a matter of debate among radiation oncologists, with concerns about lung and cardiac toxic effects, commonly linked to suboptimal radiotherapy techniques, especially following internal mammary lymph node irradiation. While most clinicians irradiated the nondissected part of the axilla including the supraclavicular lymph node area in high-risk patients, irradiation of the internal mammary lymph nodes was used variably. After the publications of the meta-analyses of the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), a renewed interest in the role of comprehensive nodal irradiation emerged for all node-positive breast cancer patients, irrespective of the extent of nodal involvement.1
Poortmans PMP, Coles C, Bernier J. Treatment of Regional Lymph Nodes in Breast Cancer—Evidence in Favor of Radiation Therapy. JAMA Oncol. 2016;2(8):989–990. doi:10.1001/jamaoncol.2016.0183
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