Should all women with positive nodes in breast cancer receive comprehensive nodal irradiation?—No.
I would say that some node-positive patients should get comprehensive nodal irradiation (RT), but I don’t believe the current data supports its use in all node-positive patients, particularly in patients with 1 to 3 positive nodes. Advocates for routine use of comprehensive nodal RT in node-positive patients point to 2 main sources: the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analysis of post-mastectomy RT (PMRT),1 and the MA.20 clinical trial.2
Harris JR. Treatment of Regional Lymph Nodes in Breast Cancer—Not Recommended for All Patients With 1 to 3 Positive Auxiliary Nodes. JAMA Oncol. 2016;2(8):991–992. doi:10.1001/jamaoncol.2016.0222
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