How do you treat women who have breast-conserving surgery with positive sentinel node/s and no axillary dissection?

My understanding of this literature is very similar to @Dr. First Last, whose answer I wholeheartedly support.

Z-11 asked and answered a surgical question. In clinically node (-) women with 1-2 + SLNs, there was no benefit to ALNDx. Some people note that in Z-11 the regional nodal recurrence rate was...

Since this has been adopted as standard of care by breast surgeons and ASCO guidelines, this would be norm rather than the exception. Even though not required in the Z 11 protocol, some radiation oncologists did modify field treated including variable nodal volume which makes data interpretation dif...

I agree with @Dr. First Last, in general. Where I struggle is when to add the superclav field. For micro mets, I never do, but even if technically a macro met (2mm), if the MRI didn't demonstrate any other obvious positive nodes, I may still just use high tangents.

The new question today is, given ...

It may be worth mentioning that the radiation field designs from the ACOSOG Z0011 trial were recently reported:

http://www.ncbi.nlm.nih.gov/pubmed/25135994

The ACOSOG Z0011 article doesn't really address the question on whether nodes were treated. When you look at radiation therapy treatment planning books, the axillary targets often will extend to the humerus. High tangents were described as up to within 2 cm of the humerus.

Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised, multicentre, open-label, phase 3non-inferiority trial

This is the trial that gave me the comfort of treating patients with +SLN with RT without an axillary dissection.

"Axil...