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August 2016

Treatment of Regional Lymph Nodes in Breast Cancer—Not Recommended for All Patients With 1 to 3 Positive Auxiliary Nodes

Author Affiliations
  • 1Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Oncol. 2016;2(8):991-992. doi:10.1001/jamaoncol.2016.0222

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