Given the final publication of NSABP B-51, for which patients meeting trial eligibility would you still recommend regional nodal irradiation?

The very first thing that should occur before one makes a decision about what they are going to do is to understand how the trial was designed and who was actually accrued to it. The first point is that B51 was a superiority and not a non-inferiority trial. A very related point to that is that they ...

Most foundational studies informing regional nodal management were conducted in the adjuvant setting, meaning that we had comparatively limited insight into the effectiveness of systemic therapy for an individual patient when deciding whether to offer RNI (or axillary surgery for that matter). NSABP...

This will generate varied responses. For the most part, I would not favor RT if pretreating imaging suggests 1-3 level 1 and 2 node only, targeted nodal biopsy done to document the clipped node removed, and pCR or major pathological response in the breast. Would consider if pretreatment information ...

Great points discussed here!

I couldn't agree more on the brilliant analysis by Dr. @Dr. First Last.

Reading carefully through Dr. @Dr. First Last's comments, I agree with many points discussed, and I think the results should be interpreted very cautiously in light of the very heterogeneous population...

While I agree that it is reasonable to be cautious in the interpretation and the widespread application of the B51 results, it is also important to keep in mind that there is the potential to cause real harm to our patients with the addition of RNI. Balancing this risk against the possible benefits ...