Can I treat breast nodal volumes with hypofractionation?

Yes. Published randomized trials have treated/reported 2,000 patients with doses of >2 Gy in hypofractionation vs standard fractionation trials with treatment to the axilla. Trials include Start A/B (513 patients), the old trial by Ragaz et al., PMID 15657341 (318 patients, hypox 37.5 Gy in 15 fx), ...

The above discussion is wonderful. I'd like to add a bit by looking to the future. I am aware of 7 active RCTs evaluating the safety and efficacy of moderate hypofractionation and 2.5 RCTs evaluating extreme hypofractionation in RNI. Ultimately, we will have a large dataset from diverse countries to...

At our institution we are running two sister trials of hypofractionation for intact breast and PMRT patients, in which we allow nodal RT with the same shortened schedule. I get a lot of questions on this, specifically with reference to our rationale/consideration of brachial plexopathy toxicity. Whe...

Adding a meta-analysis addressing this issue to some degree:

Liu et al., PMID 31952507.

I would personally caution the use of hypofractionation for nodal volumes due to the late risk of brachial plexopathy and would suggest that even 5 years of follow-up does not allow for adequate time to assess the risk of nerve damage.

Khan et al., PMID 28900318